Doctor Name: | MR. REID ELLIOT BOUCHARD |
NPI Number: | 1104253855 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPT |
License Number: | PT40403 |
Business Practice Address: | 3905 Waring Rd Oceanside, CA - 920564405 |
Business Phone Number: | 7607249000 |
Business Fax Number: | 7607243686 |
Mailing Address: | 10835 Elderwood Rd, SAN DIEGO |
State: | CA |
Postal Code: | 921311559 |
Phone Number: | 8587221884 |
Fax Number: | |
NPI Enumeration Date: | 09/26/2013 |
NPI Last Update Date: | 05/04/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT40403 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |