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1649887076
TYLER BOUCHARD
DAVIS, CA
NPI
1649887076
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: CA PTA50692)
Enumeration Date
2020-09-29
Last Update Date
2020-09-29
Business Address
TYLER BOUCHARD
1515 SHASTA DR
DAVIS, CA 95616-6691
Phone number: 707-803-3156
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Mailing Address
TYLER BOUCHARD
4560 SE INTERNATIONAL WAY STE 100
MILWAUKIE, OR 97222-4628
Phone number:
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