Individual
JACOB PAUL BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1235 DAKOTA DR STE L, GRAFTON, WI 53024-9477
(262) 376-2085
Mailing address
2001 ALFORD PARK DR, KENOSHA, WI 53140-1927
(262) 424-5253
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
17078-24
WI
Other
Enumeration date
03/02/2020
Last updated
03/27/2025
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