Andrea Roush, PT, MBA, C/NDT, CEIS

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

12141 Issued in MA

Practice address

126 Phoenix Avenue, Building #2
Thom Anne Sullivan Early Intervention Program
Lowell, MA 01852

Phone

(978) 453-8331

NPI assigned

Jul 25, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Business Administration

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Douglas a. Thom Clinic, Inc.

  • Developmental Disabilities Clinic/Center
  • Lowell, MA
  • NPI 1396771820
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406246400000",
    "number": "1396153052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 PHOENIX AVENUE, BUILDING #2",
            "address_2": "THOM ANNE SULLIVAN EARLY INTERVENTION PROGRAM",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "01852",
            "telephone_number": "978-453-8331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 PHOENIX AVENUE, BUILDING #2",
            "address_2": "THOM ANNE SULLIVAN EARLY INTERVENTION PROGRAM",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "01852",
            "telephone_number": "978-453-8331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSH",
        "first_name": "ANDREA",
        "name_prefix": "Mrs.",
        "credential": "PT, MBA, C/NDT, CEIS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-25",
        "last_updated": "2014-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "MA",
            "license": "12141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher James Rossi, RN
• Jennifer Marie Rossignol, LCSW
• Kristen Theresa Rossino, MSW
• Melissa Nichole Rougier, MA
• Brent T Rourke
• Katiuska Rowe
• Kimle Rowe, RN
• Caitlin Marie Rowland, OTR/L
• Kathleen Roy
• Marc Roy, MD

• Pediatric Physical Therapist in Lowell, MA
• Providers in Lowell, MA by specialty
• Pediatric Physical Therapist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.