| Doctor Name: | DR. ANDY JOSEPH ROUSSEL |
| NPI Number: | 1417920117 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M. |
| License Number: | 0103300955 |
| Business Practice Address: | 1721 Financial Loop Lake Ridge, VA - 221922460 |
| Business Phone Number: | 7034919500 |
| Business Fax Number: | 7034919994 |
| Mailing Address: | 1721 Financial Loop, LAKE RIDGE |
| State: | VA |
| Postal Code: | 221922460 |
| Phone Number: | 7034919500 |
| Fax Number: | 7034919994 |
| NPI Enumeration Date: | 02/12/2006 |
| NPI Last Update Date: | 05/22/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 0103300955 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |