IndividualActive
Jacob Boucher
NPI 1619501442 · Orthopedic Physical Therapist · Grafton, WI
Provider details
- NPI number
- 1619501442
- Entity type
- Individual
- Primary specialty
- Orthopedic Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Sex
- Male
- Sole proprietor
- Yes
- License
- 17078-24 (WI)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
1235 Dakota Dr Ste L
Grafton, WI 53024-9477
Phone: (262) 376-2085
Approximate (ZIP-level) locationGet directions
Mailing address
2001 Alford Park Dr
Kenosha, WI 53140-1927
Registry dates
- Enumerated
- 2020-03-02
- Last updated
- 2025-03-27
- Certified
- 2025-03-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.