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NPI Code Detail

MEDICARE: TAMMY H BOUCHARD LPTA

MEDICARE: TAMMY H BOUCHARD LPTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2306000583VA

General Provider Information

NPI Number : 1205507365
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY H BOUCHARD LPTA
Provider Business Mailing Address
First Line : 108 BLACKSMITH ARCH
Second Line :
City : YORKTOWN
State : VA
Zip : 23693-4506
Country : US
Telephone Number : 757-739-4697
Fax Number :
Provider Business Practice Location Address
First Line : 3540 VICTORY BLVD
Second Line :
City : YORKTOWN
State : VA
Zip : 23693-3641
Country : US
Telephone Number : 757-230-2202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2021
Last Update Date : 09/27/2021

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Directions to “ TAMMY H BOUCHARD LPTA” Practice Location

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