| Matthew Charles Bouche, PT, CSCS | |
|
2155 Ford Parkway, St. Paul, MN 55116-1862 | |
| (651) 696-5010 | |
| Not Available |
| Full Name | Matthew Charles Bouche |
|---|---|
| Gender | Male |
| Speciality | Physical Therapist - Sports |
| Location | 2155 Ford Parkway, St. Paul, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033785027 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2251X0800X | Physical Therapist - Orthopedic | 11806 (Minnesota) | Secondary |
| 2251S0007X | Physical Therapist - Sports | 11806 (Minnesota) | Primary |
| Provider Name | Fairview Express Care |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1053952606 PECOS PAC ID: 3375645179 Enrollment ID: O20081028000548 |
| Provider Name | Tria Orthopaedic Center Llc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1518273085 PECOS PAC ID: 3173570561 Enrollment ID: O20110310000999 |
| Mailing Address | Practice Location Address |
|---|---|
| Matthew Charles Bouche, PT, CSCS 3519 Sawgrass Trl E, Eagan, MN 55123-1367 Ph: (920) 621-7074 | Matthew Charles Bouche, PT, CSCS 2155 Ford Parkway, St. Paul, MN 55116-1862 Ph: (651) 696-5010 |
Ms. Jacqueline Kay Harry, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: Medcentra, 225 N. Smith Ave, Suite 301, St. Paul, MN 55102 Phone: 651-288-5180 | |
Alice Mangen Engelhardt, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 640 Jackson Street, St. Paul, MN 55101 Phone: 651-254-2032 | |
Mrs. Mary E. A. Horoshak, D.P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 155 S Wabasha St, Suite 130, St. Paul, MN 55107 Phone: 651-290-7047 | |
Jennifer L Steele, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: United Hospital, 333 North Smith Avenue, St. Paul, MN 55102 Phone: 651-241-8290 | |
Linda Reinhart, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 640 Jackson Street, St. Paul, MN 55101 Phone: 651-254-3071 Fax: 651-254-0910 | |
Mrs. Jennifer Lyn Sherman, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 333 Smith Ave N, St. Paul, MN 55102 Phone: 651-241-8290 |