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General NPI Number Information
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NPI Number | 1598443855
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Entity Type | Organization
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Legal Business Name | CAROLYN BOUCHER PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 639 SHERMAN ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3060
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Country | US
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Telephone | 630-747-8763
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Fax |
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Provider Business Mailing Address
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Address Line | 639 SHERMAN ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3060
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Country | US
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Telephone | 630-747-8763
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. CAROLYN BOUCHER
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Credential |
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Telephone | 630-747-8763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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