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
1	225200000X	Physical Therapy Assistant	2306000583	VA

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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