Provider Demographics
NPI:1851605067
Name:BOUCHER, BARBARA (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 BOLTON RD
Mailing Address - Street 2:U1249
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06269-1249
Mailing Address - Country:US
Mailing Address - Phone:860-486-8080
Mailing Address - Fax:860-486-8081
Practice Address - Street 1:843 BOLTON RD
Practice Address - Street 2:U1249
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06269-1249
Practice Address - Country:US
Practice Address - Phone:860-486-8080
Practice Address - Fax:860-486-8081
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist