Provider Demographics
NPI:1659556355
Name:BOURDEAU, LAWRENCE (DPT, ATC, CSCS, OTC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:BOURDEAU
Suffix:
Gender:M
Credentials:DPT, ATC, CSCS, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 TURNPIKE ST STE 200
Mailing Address - Street 2:OFF-SEASON SPORTS & PHYSICAL THERAPY
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6327
Mailing Address - Country:US
Mailing Address - Phone:978-688-6181
Mailing Address - Fax:978-688-5120
Practice Address - Street 1:1820 TURNPIKE ST STE 200
Practice Address - Street 2:OFF-SEASON SPORTS & PHYSICAL THERAPY
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6327
Practice Address - Country:US
Practice Address - Phone:978-688-6181
Practice Address - Fax:978-688-5120
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18051225100000X
MA18452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer