Individual
TYLER BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1515 SHASTA DR, DAVIS, CA 95616-6691
(707) 803-3156
Mailing address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA50692
CA
Other
Enumeration date
09/29/2020
Last updated
09/29/2020
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