Healthcare Provider Details

I. General information

NPI: 1326953449
Provider Name (Legal Business Name): JENNA BOUCHER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2172 MASSACHUSETTS AVE
CAMBRIDGE MA
02140-1902
US

IV. Provider business mailing address

703 GRANITE ST STE 3
BRAINTREE MA
02184-5350
US

V. Phone/Fax

Practice location:
  • Phone: 617-915-8082
  • Fax: 617-915-8083
Mailing address:
  • Phone: 781-961-3370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL89763
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: