Individual
MATTHEW CHARLES BOUCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, CSCS
Contact information
Practice address
2155 FORD PARKWAY, ST. PAUL, MN 55116-1862
(651) 696-5010
Mailing address
3519 SAWGRASS TRL E, EAGAN, MN 55123-1367
(920) 621-7074
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
11806
MN
2251X0800X
Orthopedic Physical Therapist
11806
MN
Other
Enumeration date
06/01/2021
Last updated
06/01/2021
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