Richard W Bousson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070022124 Issued in IL

Practice address

6255 S Archer Ave
Chicago, IL 60638-2609

Phone

(773) 284-6735

Fax

(773) 284-6820

NPI assigned

Aug 3, 2015

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

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Athletico LTD

  • Physical Therapist
  • Oak Brook, IL
  • NPI 1821085028
  NPD
• Premise Health of Illinois Medical PC

  • Multi-Specialty Clinic/Center
  • Lisle, IL
  • NPI 1073025235
  NPD
• Premise Health of Illinois Medical PC

  • Multi-Specialty Clinic/Center
  • Utica, IL
  • NPI 1295518868
  NPD
• Premise Health of Illinois Medical PC

  • Primary Care Clinic/Center
  • Mount Vernon, IL
  • NPI 1427366921
  NPD
• Athletico LTD

  • Clinic/Center
  • Lafayette, IN
  • NPI 1053044867

  Physical Therapist

  NPD

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

{
    "created_epoch": "1438560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572566400000",
    "number": "1275919136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 ENTERPRISE DR",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605238813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6255 S ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606382609",
            "telephone_number": "773-284-6735",
            "fax_number": "773-284-6820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUSSON",
        "first_name": "RICHARD",
        "middle_name": "W",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-03",
        "last_updated": "2019-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501017277",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070022124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas E. Bournias, M.D.
• Athina Bouroukas, MD
• Abigail Andersen Boursiquot, CCC-SLP
• Jackie Lynn Bousek, ATR, LCPC
• Ava P Bousher
• Joseph Thomas Boutet, PA-C
• Catherine-Audrey Boutin, M.D.
• Andrew Stephen Boutsicaris
• Alexandra Boutsikakis
• Harold Joseph Boutte Jr., M.D.

• All providers in Chicago, IL
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2019; 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.