Provider Demographics
NPI:1376983668
Name:BJORHUS, TYLER EDWARD (DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:EDWARD
Last Name:BJORHUS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 E LAKE ST
Mailing Address - Street 2:APT 4636
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2358
Mailing Address - Country:US
Mailing Address - Phone:701-238-5622
Mailing Address - Fax:
Practice Address - Street 1:4610 E LAKE ST
Practice Address - Street 2:APT 4636
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2358
Practice Address - Country:US
Practice Address - Phone:701-238-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist