Individual
TYLER BURCHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3170 43RD ST S, SUITE 101, FARGO, ND 58104-8908
(701) 277-8448
(701) 277-8668
Mailing address
1560 S CAROL ST, MERIDIAN, ID 83646-1839
(208) 288-1155
(208) 288-0424
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
PT2542
ID
225100000X
Physical Therapist
Primary
1738
ND
225100000X
Physical Therapist
PT-2542
ID
Other
Enumeration date
08/04/2009
Last updated
06/06/2013
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