Healthcare Provider Details

I. General information

NPI: 1881683431
Provider Name (Legal Business Name): BOUCHARD PHYSICAL THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 SILVER ST
WATERVILLE ME
04901-5813
US

IV. Provider business mailing address

160 RIVERSIDE DR
AUGUSTA ME
04330-4162
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-4638
  • Fax: 207-873-1541
Mailing address:
  • Phone: 207-622-9467
  • Fax: 207-623-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANE E CHAPMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 207-622-9467