Katie Boudreau

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160.006489 Issued in IL

Practice address

1601 Butterfield TRL
Kankakee, IL 60901-2959

Phone

(815) 936-6500

NPI assigned

Jan 3, 2014

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1388707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388707200000",
    "number": "1801217153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6170 W 2000N RD",
            "city": "BONFIELD",
            "state": "IL",
            "postal_code": "609136700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 BUTTERFIELD TRL",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012959",
            "telephone_number": "815-936-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "KATIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-03",
        "last_updated": "2014-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160.006489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bipin N. Bhayani M.D.,S.C.
• Bipin N. Bhayani M.D.,S.C.
• Jennifer Blanchette, PT
• Kaity Bobadilla, DO
• Jacob Borrelli, DO
• Karim H Bouferrache, PA-C
• Nathan James Bowers, PTA
• Julene S. Bowley-Vogen, LCSW
• Joyce Lynne Bowman, FNP-BC
• Umaimah Boxwalla, DO

• Physical Therapy Assistant in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2014; 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.