MEDICARE: BOUCHARD PHYSICAL THERAPY SERVICES INC

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	225100000X	Physical Therapist

Other Identifiers

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

General Provider Information

NPI Number	:	1881683431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOUCHARD PHYSICAL THERAPY SERVICES INC

Provider Business Mailing Address
First Line	:	160 RIVERSIDE DR
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-4162
Country	:	US
Telephone Number	:	207-622-9467
Fax Number	:	207-623-2874

Provider Business Practice Location Address
First Line	:	149 SILVER ST
Second Line	:
City	:	WATERVILLE
State	:	ME
Zip	:	04901-5813
Country	:	US
Telephone Number	:	207-873-4638
Fax Number	:	207-873-1541

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. JANE E CHAPMAN
Credential	:
Telephone Number	:	207-622-9467

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	02/26/2013

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