Provider Demographics
NPI:1255944435
Name:BOUCHER, ADRIANNA (DPT)
Entity type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 YARDVILLE ALLENTOWN RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-1866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1278 YARDVILLE ALLENTOWN RD STE 3
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08501-1866
Practice Address - Country:US
Practice Address - Phone:609-738-3143
Practice Address - Fax:609-738-3144
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01940400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist