Provider Demographics
NPI:1780629196
Name:BUEGE, TYLER (PT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:BUEGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 N PARKE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2436
Practice Address - Country:US
Practice Address - Phone:410-297-8141
Practice Address - Fax:410-297-8142
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3530512000OtherIBC
646930-03OtherBCBS OF MARYLAND
5070-0095OtherGHMSI
T208OtherBLUECHOICE/GHMSI
1780629196OtherCHAMPUS TRICARE
2160584OtherACN
2160584OtherUHC
7914198OtherAETNA
MDP01033243OtherMEDICARE RAILROAD
88760511OtherCARE FIRST
1780629196OtherCHAMPUS TRICARE
7914198OtherAETNA
T208OtherBLUECHOICE/GHMSI