Edward J Boudreau, PT, OCS

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

15110 Issued in MA

Practice address

16 Hayden Ave
Lexington, MA 02421-7929

Phone

(781) 372-7000

NPI assigned

Oct 26, 2006

Last updated

Oct 21, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lahey Clinic, Inc

  • Internal Medicine Physician
  • Peabody, MA
  • NPI 1063447316
  Medicare reassignment NPD
• Lahey Clinic, Inc.

  dba Lahey Clinic

  • Internal Medicine Physician
  • Burlington, MA
  • NPI 1538194980
  Medicare reassignment NPD

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1043395007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 COLLINS ST",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019233537",
            "telephone_number": "978-766-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 HAYDEN AVE",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024217929",
            "telephone_number": "781-372-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "EDWARD",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "PT, OCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "33177",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MA",
            "license": "15110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boston Pain Solutions PC
• Harvey Irwin Botman, PH.D.
• Celeste Bouchard
• Christine Marie Bouchard, LICSW
• Madlyna Bouchotte
• Sherly Bourdeau
• David Bowen
• Michael Bowes, BCBA
• Sally Independence Bowie, LICSW
• Bowlight Partners LLC (Banyan Health)

• Orthopedic Physical Therapist in Lexington, MA
• Providers in Lexington, MA by specialty
• Orthopedic Physical Therapist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.