| Doctor Name: | MR. EDWARD J BOUDREAU |
| NPI Number: | 1043395007 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, OCS |
| License Number: | 33177 |
| Business Practice Address: | 850 Boylston St Suite 200 Chestnut Hill, MA - 024672477 |
| Business Phone Number: | 6177329525 |
| Business Fax Number: | |
| Mailing Address: | 131 Collins St, DANVERS |
| State: | MA |
| Postal Code: | 019233537 |
| Phone Number: | 9787660880 |
| Fax Number: | |
| NPI Enumeration Date: | 10/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 33177 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |