Individual
MR. LAWRENCE BOURDEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, ATC, CSCS, OTC
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
18051
MA
2255A2300X
Athletic Trainer
1845
MA
Other
Enumeration date
01/02/2008
Last updated
10/21/2010
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