Jacob Paul Boucher
NPI 1619501442ActiveIndividual· Physical Therapist, Orthopedic· Grafton, WI
Physical Therapist, Orthopedic with Freedom Physical Therapy Services SC, practicing in Grafton, Wisconsin. Enrolled in Medicare as practitioner - physical therapist in private practice.
Overview
| NPI | 1619501442 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | Yes |
| NPI issued | Mar 2, 2020 |
| Last updated in NPPES | Mar 27, 2025 |
| Certified by provider | Mar 27, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist, Orthopedic Primary | 2251X0800X | 17078-24 | WI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (WI) |
|---|
Education and affiliations
| Graduation year | 2024 |
|---|---|
| Medicare specialty | Physical Therapist In Private Practice |
Medical group
- Freedom Physical Therapy Services SCFox Point, WI · 31 clinicians
Other orthopedic physical therapists in Grafton
- 1427185339
- 1679918171