Individual provider Active NPI

Jennifer Marie Boudreau, P.T.

  • Physical Therapist
  • Tequesta, FL
National Provider Identifier
1891818936
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT42213 Issued in FL
Practice address
138 Magnolia Way
Tequesta, FL 33469-2132
Phone
(732) 371-8980
NPI assigned
Apr 6, 2007
Last updated
Aug 14, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT42213 FL Primary
Physical Therapist 225100000X 40QA00811400 NJ

Addresses

Primary practice location

138 Magnolia Way
Tequesta, FL 33469-2132

Mailing address

138 Magnolia Way
Tequesta, FL 33469-2132
Phone (732) 371-8980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080410000154 NJ Practitioner - Physical Therapist in Private Practice 4385721604 Reassigns benefits to 2 organizations
I20240916002309 FL Practitioner - Physical Therapist in Private Practice 4385721604 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
83.26 of 100Reported as group
Quality
86.58
Improvement activities
40
Cost
68.79

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT42213FLMDPhysical Therapist
40QA00811400NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Luna Care Physical Therapy LLC Physical Therapist CurrentSince Aug 19, 2024 Accepting new patients
Ivyrehab Network Inc. Physical Therapist Current Accepting new patients
Prime Physical Therapy & Sports Care LLC Physical Therapist CurrentSince Feb 11, 2019 Accepting new patients
Atlantic Physical Therapy Center CurrentSince Nov 23, 2020 Accepting new patients
Ivyrehab Network, Inc. Physical Therapist CurrentSince Dec 17, 2018 Accepting new patients
Atlantic Physical Therapy Center Physical Therapist CurrentSince Nov 23, 2020 Accepting new patients
Ivyrehab Network Inc Physical Therapist CurrentSince Dec 17, 2018 Accepting new patients

Locations

5011 Gate Pkwy
Ste 100
Jacksonville, FL 32256
Phone (904) 326-3627

731 Lacey Rd
Ste 3
Forked River, NJ 08731
Phone (609) 242-6780

160 White Rd
Ste 104
Little Silver, NJ 07739
Phone (732) 383-8295

1037 Route 70
Manchester, NJ 08759
Phone (732) 408-1800

127 Ark Rd
Ste 23
Mount Laurel, NJ 08054
Phone (609) 714-7730

2005 State Route 35
Ste 21
Oakhurst, NJ 07755
Phone (732) 240-9296

1500 Meeting House Rd
Sea Girt, NJ 08750
Phone (732) 784-6545

1131 Broad St
Ste 301
Shrewsbury, NJ 07702
Phone (732) 440-1596

656 Shrewsbury Ave
Ste 103
Tinton Falls, NJ 07701
Phone (732) 842-4198

1377 Motor Pkwy
Ste 307
Ronkonkoma, NY 11749

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1891818936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 MAGNOLIA WAY",
            "city": "TEQUESTA",
            "state": "FL",
            "postal_code": "334692132",
            "telephone_number": "732-371-8980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 MAGNOLIA WAY",
            "city": "TEQUESTA",
            "state": "FL",
            "postal_code": "334692132",
            "telephone_number": "732-371-8980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-06",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT42213",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00811400",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tequesta, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; 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.