Individual
TYLER ZACHARY BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1302 HEYWARD ST, COLUMBIA, SC 29208-3407
(262) 765-1267
Mailing address
402 S MORELAND BLVD, WAUKESHA, WI 53188-4912
(262) 765-1267
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000038516
SC
Other
Enumeration date
08/03/2021
Last updated
08/03/2021
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