Provider Demographics
NPI:1770715302
Name:BOUDREAU, OLGA ADRIANA (RPT)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:ADRIANA
Last Name:BOUDREAU
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 NW 40TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2211
Mailing Address - Country:US
Mailing Address - Phone:954-914-9175
Mailing Address - Fax:954-575-3971
Practice Address - Street 1:7005 NW 40TH CT
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-2211
Practice Address - Country:US
Practice Address - Phone:954-914-9175
Practice Address - Fax:954-575-3971
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist