Provider Demographics
NPI:1891818936
Name:BOUDREAU, JENNIFER MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:BOUDREAU
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 1:1901 FANWOOD ST
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-2708
Mailing Address - Country:US
Mailing Address - Phone:732-660-0475
Mailing Address - Fax:732-933-3574
Practice Address - Street 1:160 WHITE RD
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1165
Practice Address - Country:US
Practice Address - Phone:732-933-3570
Practice Address - Fax:732-933-3574
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00811400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist