Bruce Bourbeau, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

910 Issued in NH

Practice address

235 Myrtle St
Manchester, NH 03104-4314

Phone

(603) 627-3811

NPI assigned

Aug 18, 2009

Last updated

Aug 18, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Genesis Eldercare Rehab SVCS

  • Skilled Nursing Facility
  • Manchester, NH
  • NPI 1932337110
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250553600000",
    "number": "1013149418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 WELLINGTON HILL RD",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031046463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 MYRTLE ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031044314",
            "telephone_number": "603-627-3811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURBEAU",
        "first_name": "BRUCE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-18",
        "last_updated": "2009-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NH",
            "license": "910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonquille Bouchard, D.O.
• Bryan David Boucher, RPH
• Chastity J Boucher, MSN
• Matthew Bouchie, BA
• Kamresse Bounds, BA
• Ashleigh Rebecca Bourgeois
• Jamie J Bourgeois, CNM
• Amy Regina Bourne, LCSW
• Kimberly Marie Bouse, BSW
• Michelle Boutin, MA

• Physical Therapy Assistant in Manchester, NH
• Providers in Manchester, NH by specialty
• Physical Therapy Assistant in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.