Active NPI
Matthew Joseph Bouchard, D.P.T.
- Physical Therapist
- Bangor, ME
National Provider Identifier
1174820518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT3456
- Practice address
- 404 State St
Suite #610
Bangor, ME 04401-6623 - Phone
- (207) 947-8381
- NPI assigned
- Feb 21, 2011
- Last updated
- Feb 21, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT3456 | ME | Primary |
Addresses
Primary practice location
404 State St
Suite #610
Bangor, ME 04401-6623
Mailing address
27 Airport Rd
Enfield, ME 04493-4455
Phone (207) 659-2258
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Down East Orthopedic Assoc PA | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298246400000",
"number": "1174820518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27 AIRPORT RD",
"city": "ENFIELD",
"state": "ME",
"postal_code": "044934455",
"telephone_number": "207-659-2258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 STATE ST",
"address_2": "SUITE #610",
"city": "BANGOR",
"state": "ME",
"postal_code": "044016623",
"telephone_number": "207-947-8381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCHARD",
"first_name": "MATTHEW",
"middle_name": "JOSEPH",
"name_prefix": "Mr.",
"credential": "D.P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-02-21",
"last_updated": "2011-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ME",
"license": "PT3456",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.