Kevin Robert Bouchard-Hall, PHYSICAL THERAPY

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P75321 Issued in NY

Practice address

66 Park Street
Suite 100
Elizabethtown, NY 12932-0000

Phone

(518) 873-2408

Fax

(518) 873-3205

NPI assigned

Aug 5, 2010

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Elizabethtown Community Hospital

  • Critical Access Hospital
  • Elizabethtown, NY
  • NPI 1184933475
  NPD (past)

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280966400000",
    "number": "1710291356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 PARK ST",
            "city": "ELIZABETHTOWN",
            "state": "NY",
            "postal_code": "12932",
            "telephone_number": "518-873-2408",
            "fax_number": "518-873-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 PARK STREET",
            "address_2": "SUITE 100",
            "city": "ELIZABETHTOWN",
            "state": "NY",
            "postal_code": "129320000",
            "telephone_number": "518-873-2408",
            "fax_number": "518-873-3205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHARD-HALL",
        "first_name": "KEVIN",
        "middle_name": "ROBERT",
        "credential": "PHYSICAL THERAPY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-05",
        "last_updated": "2010-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "P75321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Elizabethtown, NY
• Providers in Elizabethtown, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2010; 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.