Provider Demographics
NPI:1558692566
Name:BUSHNELL, TAYLOR HAMILTON (DPT)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:HAMILTON
Last Name:BUSHNELL
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 1:2376 35TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-6724
Mailing Address - Country:US
Mailing Address - Phone:541-206-3403
Mailing Address - Fax:
Practice Address - Street 1:360 S GARDEN WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8173
Practice Address - Country:US
Practice Address - Phone:541-338-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18920225100000X
OR6339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist