Provider Demographics
NPI:1184603821
Name:BOHNET, TYLER MARC (MPT)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:MARC
Last Name:BOHNET
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52194
Mailing Address - Street 2:DEPT CODE 960
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-2194
Mailing Address - Country:US
Mailing Address - Phone:503-489-1781
Mailing Address - Fax:503-489-1650
Practice Address - Street 1:308 N IVY ST
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3704
Practice Address - Country:US
Practice Address - Phone:503-263-6786
Practice Address - Fax:503-263-6451
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 4082225100000X
WAPT 00008327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
30062200OtherREGENCE HMO
825473002OtherREGENCE PPO
OR226568Medicaid
K981106OtherPACIFIC SOURCE
ORR114519Medicare PIN
ORR114556Medicare PIN
ORR143925Medicare PIN
K981106OtherPACIFIC SOURCE
OR226568Medicaid
ORR143723Medicare PIN