Individual
MR. TYLER MARC BOHNET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
308 N IVY ST, CANBY, OR 97013-3704
(503) 263-6786
(503) 263-6451
Mailing address
PO BOX 52194, DEPT CODE 960, PHOENIX, AZ 85072-2194
(503) 489-1781
(503) 489-1650
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
OR 4082
OR
225100000X
Physical Therapist
PT 00008327
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226568
—
OR
01
—
30062200
REGENCE HMO
—
01
—
825473002
REGENCE PPO
—
01
—
K981106
PACIFIC SOURCE
—
Enumeration date
01/11/2006
Last updated
11/19/2008
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