Provider Demographics
NPI:1639851017
Name:BROUILLARD, PETER (DPT)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BROUILLARD
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SHAKER RD STE C200
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01464-2525
Mailing Address - Country:US
Mailing Address - Phone:978-615-9121
Mailing Address - Fax:978-245-2338
Practice Address - Street 1:2 SHAKER RD STE C200
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:MA
Practice Address - Zip Code:01464-2525
Practice Address - Country:US
Practice Address - Phone:978-615-9121
Practice Address - Fax:978-245-2338
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTL23118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist