Provider Demographics
NPI:1043467079
Name:BOUCHARD, JULIE M (DPT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:BOUCHARD
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 1:118 BENNETT DR STE 140
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2052
Mailing Address - Country:US
Mailing Address - Phone:207-498-6334
Mailing Address - Fax:207-493-3247
Practice Address - Street 1:118 BENNETT DR STE 140
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736
Practice Address - Country:US
Practice Address - Phone:207-498-6334
Practice Address - Fax:207-493-3247
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist