Jacob Paul Boucher

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

17078-24 Issued in WI

Practice address

1235 Dakota Dr Ste L
Grafton, WI 53024-9477

Phone

(262) 376-2085

NPI assigned

Mar 2, 2020

Last updated

Mar 27, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 WI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Freedom Physical Therapy Services SCGroup PAC ID 8224938113, 29 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Freedom Physical Therapy Services SC

  • Physical Therapist
  • Fox Point, WI
  • NPI 1063406544

  Orthopedic

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1583107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743033600000",
    "number": "1619501442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 ALFORD PARK DR",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531401927",
            "telephone_number": "262-424-5253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 DAKOTA DR STE L",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530249477",
            "telephone_number": "262-376-2085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHER",
        "first_name": "JACOB",
        "middle_name": "PAUL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-02",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "WI",
            "license": "17078-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Francois Blumenfeld-Kouchner, D.O.
• Brenda Blunt, APNP
• Body Renovation Health Services, S.C.
• Body Renovation Physical Therapy SC
• Melinda C Bonilla-Puetz, MD
• Brian William Bradley, PH.D.
• Andrew M Brand
• Caroline Marie Brandt, AGACNP-BC
• Allison Kimball Brown
• Kirk John Brown, M.D.

• Orthopedic Physical Therapist in Grafton, WI
• Providers in Grafton, WI by specialty
• Orthopedic Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.