Basic Information
| Provider Information | |||||||||
| NPI: | 1225126113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUROCHER | ||||||||
| FirstName: | DONNA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962222 | ||||||||
| FaxNumber: | 6307599510 | ||||||||
| Practice Location | |||||||||
| Address1: | 168 DENSLOW ROAD | ||||||||
| Address2: | |||||||||
| City: | EAST LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135269924 | ||||||||
| FaxNumber: | 4135269961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 05/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5320 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 043527 | 01 | MA | CONNECTICARE GROUP NO | OTHER | 043527497 | 01 | MA | CONSOLIDATE HEALTH PLANS | OTHER | 11539624 | 01 | CAQH | OTHER | 4265439 | 01 | AETNA INDIVIDUAL NO | OTHER | Y61264 | 01 | MA | BLUE CROSS BLUE SHIELD GROUP NO | OTHER | 337847 | 01 | MA | TUFTS INDIVIDUAL NO | OTHER | 9715568 | 05 | MA | MEDICAID | P00420770 | 01 | MA | PALMETTO RR MEDICARE | OTHER | 000000035257 | 01 | MA | BOSTON MEDICAL HEALTHNET GROUP NO | OTHER | 043527497 | 01 | MA | GIC/UNICARE | OTHER | 043527497 | 01 | MA | PIONEER | OTHER | 080005320MA06 | 01 | ANTHEM BCBS | OTHER | 080005320MA07 | 01 | ANTHEM BCBS | OTHER | 28117 | 01 | MA | HEALTH NEW ENGLAND GROUP NO | OTHER | 690675 | 01 | MA | TUFTS GROUP NO | OTHER | 103355100 | 01 | MA | DEPARTMENT OF LABOR | OTHER | 000000035324 | 01 | MA | BOSTON MEDICAL HEALTH NET | OTHER | 043527497 | 01 | AETNA GROUP NO | OTHER | 0704709 | 05 | MA | MEDICAID | 972730 | 01 | MA | NETWORK HEALTH GROUP | OTHER | Y65488 | 01 | BLUE CROSS BLUE SHIELD INDIDUAL NO | OTHER | 1587870 | 01 | MA | CIGNA INDIVIDUAL NO | OTHER | 043527497 | 01 | MA | CIGNA GROUP NO | OTHER | 043527497 | 01 | MA | GREATWEST | OTHER | 043527497 | 01 | MA | NORTH REGIONS | OTHER | 043527497 | 01 | MA | UNITED HEALTH CARE | OTHER |