Brad Boulanger, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

18835 Issued in MA

Practice address

711 W Center St
W Bridgewater, MA 02379

Phone

(085) 659-4499

Fax

(508) 510-4987

NPI assigned

Oct 23, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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 and National Provider Directory roles.

• Bay State Physical Therapy of Randolph Inc

  • Physical Therapist
  • Fall River, MA
  • NPI 1164474334
  Medicare reassignment
• Bay State Physical Therapy of Randolph Inc

  • Chiropractor
  • Quincy, MA
  • NPI 1316507627
  NPD

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

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527811200000",
    "number": "1609102714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CREDIT UNION WAY FL 3",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023684633",
            "telephone_number": "781-961-3370",
            "fax_number": "781-961-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W CENTER ST",
            "city": "W BRIDGEWATER",
            "state": "MA",
            "postal_code": "02379",
            "telephone_number": "085-659-4499",
            "fax_number": "508-510-4987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULANGER",
        "first_name": "BRAD",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-23",
        "last_updated": "2018-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "18835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corinne Anne Coughlin
• Magen Ann Crepeau
• Albert Alfred Dunn III, M.D.
• Donna Dee Keane, D. MIN.
• Nicholas Kupchaunis

• Physical Therapist in W Bridgewater, MA
• Providers in W Bridgewater, MA by specialty
• Physical Therapist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2018; 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.