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Individual

DR. SPENCER ANDREW BOURASSA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PT, DPT

Contact information

Practice address
9394 W DODGE RD STE 300, OMAHA, NE 68114-3319
(800) 732-3784
Mailing address
84 RUSTIC LN, LYMAN, ME 04002-6042
(207) 590-9179

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
26806
MA
225100000X
Physical Therapist
PT39406
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PT39406
FLORIDA PT LICENSE NUMBER
FL
Enumeration date
10/12/2022
Last updated
05/18/2023
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