Individual
JOHN R BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1430 W BADDOUR PKWY, SUITE C, LEBANON, TN 37087-2656
(615) 453-1422
(615) 453-1429
Mailing address
1430 W BADDOUR PKWY, SUITE C, LEBANON, TN 37087-2656
(615) 453-1422
(615) 453-1429
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05269
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05269
PHYSICAL THERAPY LICENSE
TN
Enumeration date
07/20/2006
Last updated
10/01/2013
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