Healthcare Provider Details

I. General information

NPI: 1578601217
Provider Name (Legal Business Name): PATRICIA MARY BOUDREAU P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 PROSPECT ST SNHMC
NASHUA NH
03060-3925
US

IV. Provider business mailing address

8 PROSPECT ST SNHMC
NASHUA NH
03060-3925
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-2000
  • Fax: 603-577-2757
Mailing address:
  • Phone: 603-577-2000
  • Fax: 603-577-2757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1583
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8624
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: