Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jacob Paul Boucher

Individual provider Orthopedic Physical Therapist · NPI 1619501442

Jacob Paul Boucher is a Physical Therapist in Private Practice in Grafton, Wisconsin. Qualified in 2024, 2 years ago. Practices with Freedom Physical Therapy Services SC, a 29-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
2
Licensed in
WI
In the registry since
2020

Practice location Address checks out

1235 Dakota Dr Ste L
Grafton, WI 53024-9477
Phone: (262) 376-2085
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Orthopedic Physical Therapist (primary) Taxonomy 2251X0800X · Licence 17078-24 (WI)

Record details

NPI number1619501442
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 2, 2020
Last updated in NPPESMarch 27, 2025
Certification dateMarch 27, 2025
Mailing address2001 Alford Park Dr, Kenosha, WI 53140-1927

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Freedom Physical Therapy Services Sc — 29 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Grafton