Active NPI
David J Boucher, PT
- Physical Therapist
- E Providence, RI
National Provider Identifier
1417901190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 01754
- Practice address
- 1001 Waterman Ave
E Providence, RI 02914-1314 - Phone
- (401) 434-1773
- Fax
- (401) 435-0500
- NPI assigned
- May 19, 2006
- 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 | 01754 | RI | Primary |
Addresses
Primary practice location
1001 Waterman Ave
E Providence, RI 02914-1314
Mailing address
31 Old Route 7
Attn: Credentialing Dept
Brookfield, CT 06804-1714
Phone (203) 740-0020
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01754 | RI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carlson Therapy Network, PC | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1417901190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 OLD ROUTE 7",
"address_2": "ATTN: CREDENTIALING DEPT",
"city": "BROOKFIELD",
"state": "CT",
"postal_code": "068041714",
"telephone_number": "203-740-0020",
"fax_number": "203-775-0238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 WATERMAN AVE",
"city": "E PROVIDENCE",
"state": "RI",
"postal_code": "029141314",
"telephone_number": "401-434-1773",
"fax_number": "401-435-0500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCHER",
"first_name": "DAVID",
"middle_name": "J",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-19",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "RI",
"license": "01754",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in E Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.