Provider Demographics
NPI:1699315184
Name:RAUSCHERT, TYLER J (ATC/R)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:J
Last Name:RAUSCHERT
Suffix:
Gender:M
Credentials:ATC/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-1099
Mailing Address - Country:US
Mailing Address - Phone:541-998-2343
Mailing Address - Fax:541-998-1343
Practice Address - Street 1:1135 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-1099
Practice Address - Country:US
Practice Address - Phone:541-998-2343
Practice Address - Fax:541-998-1343
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-101171762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty