Active NPI
Spencer Andrew Bourassa, PT, DPT
- Physical Therapist
- Omaha, NE
National Provider Identifier
1770209702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 26806
- Practice address
- 9394 W Dodge Rd Ste 300
Omaha, NE 68114-3319 - Phone
- (800) 732-3784
- NPI assigned
- Oct 12, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT39406 | FL | |
| Physical Therapist | 225100000X | 26806 | MA | Primary |
Addresses
Primary practice location
9394 W Dodge Rd Ste 300
Omaha, NE 68114-3319
Mailing address
84 Rustic LN
Lyman, ME 04002-6042
Phone (207) 590-9179
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT39406 | Other | FL | FLORIDA PT LICENSE NUMBER |
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 |
|---|---|---|---|
| PT39406 | FL | MD | Physical Therapist |
| 26806 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684368000000",
"number": "1770209702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "84 RUSTIC LN",
"city": "LYMAN",
"state": "ME",
"postal_code": "040026042",
"telephone_number": "207-590-9179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9394 W DODGE RD STE 300",
"city": "OMAHA",
"state": "NE",
"postal_code": "681143319",
"telephone_number": "800-732-3784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURASSA",
"first_name": "SPENCER",
"middle_name": "ANDREW",
"name_prefix": "Dr.",
"credential": "PT, DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-10-12",
"last_updated": "2023-05-18",
"certification_date": "2023-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT39406",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "26806",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA PT LICENSE NUMBER",
"identifier": "PT39406",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.