Provider Demographics
NPI:1528322930
Name:ROULIER, LYNETTE MARY (PTA)
Entity type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:MARY
Last Name:ROULIER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:LYNETTE
Other - Middle Name:MARY
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:4852 RAINER DRIVE
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-4129
Mailing Address - Country:US
Mailing Address - Phone:615-504-7456
Mailing Address - Fax:
Practice Address - Street 1:4852 RAINER DR
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-4129
Practice Address - Country:US
Practice Address - Phone:615-504-7456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker