Active NPI
Jerry Joseph Bourassa, PHYSICAL THERAPSIT
- Specialist
- Prescott, AZ
National Provider Identifier
1376721779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1370
- Practice address
- 146 S Granite St
Prescott, AZ 86303-4710 - Phone
- (928) 717-3236
- NPI assigned
- Feb 7, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 1370 | AZ | Primary |
Addresses
Primary practice location
146 S Granite St
Prescott, AZ 86303-4710
Mailing address
146 S Granite St
Prescott, AZ 86303-4710
Phone (928) 717-3236
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1370 | AZ | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202342400000",
"number": "1376721779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "146 S GRANITE ST",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863034710",
"telephone_number": "928-717-3236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 S GRANITE ST",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863034710",
"telephone_number": "928-717-3236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURASSA",
"first_name": "JERRY",
"middle_name": "JOSEPH",
"credential": "PHYSICAL THERAPSIT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-07",
"last_updated": "2008-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AZ",
"license": "1370",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.