Individual
MICHELLE MARIE PERAULT-BOUGHTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4080 W BROADWAY AVE, #300, ROBBINSDALE, MN 55422-5604
(763) 533-0541
Mailing address
1330 XERXES AVE N, MINNEAPOLIS, MN 55411-2848
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4137
MN
Other
Enumeration date
08/25/2006
Last updated
07/08/2007
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