Individual
CATHERINE BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
34505 W 12 MILE RD STE 100, FARMINGTON HILLS, MI 48331-3287
(855) 559-7178
Mailing address
10101 HORSESHOE CIR, CLARKSTON, MI 48348-2003
(248) 421-3251
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501003311
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508823774
—
MI
05
—
5501003311
—
MI
Enumeration date
12/11/2018
Last updated
12/11/2018
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