Doctor Name: | DR. BRENDAN ROBERT BOUCHER |
NPI Number: | 1871936211 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPT, PT, CSCS |
License Number: | PT02863 |
Business Practice Address: | 565 5th St Brookings, OR - 974159724 |
Business Phone Number: | 5414691062 |
Business Fax Number: | |
Mailing Address: | 1 High St, WAKEFIELD |
State: | RI |
Postal Code: | 028793103 |
Phone Number: | 4017838077 |
Fax Number: | |
NPI Enumeration Date: | 04/16/2013 |
NPI Last Update Date: | 01/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT02863 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | RI |
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 |