Provider Demographics
NPI:1740313550
Name:BOUGHTON, ANN CATHERINE (PT)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:CATHERINE
Last Name:BOUGHTON
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 1:1426 GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2545
Mailing Address - Country:US
Mailing Address - Phone:410-349-2340
Mailing Address - Fax:
Practice Address - Street 1:610 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3346
Practice Address - Country:US
Practice Address - Phone:410-822-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15415225100000X
DEJ1-0001650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist