Provider Demographics
NPI:1609985829
Name:BOUCHER, BRENDA KENT (PT, PHD,)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:KENT
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:PT, PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 COMMON ST STE 307
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3566
Mailing Address - Country:US
Mailing Address - Phone:830-625-7310
Mailing Address - Fax:830-625-3228
Practice Address - Street 1:1324 COMMON ST STE 307
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3566
Practice Address - Country:US
Practice Address - Phone:830-625-7310
Practice Address - Fax:830-625-3228
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6192OtherBC/BS
TX8T6192OtherBC/BS