Provider Demographics
NPI:1689876492
Name:BOURGOIN, CHERYL ADAMS (PT)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ADAMS
Last Name:BOURGOIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:87 FOWLERS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-3438
Mailing Address - Country:US
Mailing Address - Phone:207-907-9068
Mailing Address - Fax:207-941-7883
Practice Address - Street 1:12 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3984
Practice Address - Country:US
Practice Address - Phone:207-945-2946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME4642251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic