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NPI Code Detail

MEDICARE: MRS. ANNIE BOUCHEREAU MPTA

MEDICARE: MRS. ANNIE BOUCHEREAU MPTA
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
1222Q00000XDevelopmental Therapist
2225100000XPhysical TherapistPT19446FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710050778
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANNIE BOUCHEREAU MPTA
Provider Business Mailing Address
First Line : 1 OAKWOOD BLVD STE 130
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33020-1937
Country : US
Telephone Number : 954-445-3064
Fax Number :
Provider Business Practice Location Address
First Line : 1 OAKWOOD BLVD STE 130
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33020-1937
Country : US
Telephone Number : 954-925-3844
Fax Number : 954-925-3845
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2006
Last Update Date : 05/09/2025

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Directions to “ MRS. ANNIE BOUCHEREAU MPTA” Practice Location

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