Individual
LYNN A BOUDREAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0643
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0804882Y0NH01
ANTHEM
NH
05
—
30390008
—
NH
01
—
42572
CIGNA
NH
Enumeration date
08/12/2006
Last updated
07/08/2007
Update your record
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