Basic Information
| Provider Information | |||||||||
| NPI: | 1356696660 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHUPE | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | AARON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16083 SW UPPER BOONES FERRY RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972247736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034436156 | ||||||||
| FaxNumber: | 5036399699 | ||||||||
| Practice Location | |||||||||
| Address1: | 170 MELTON RD | ||||||||
| Address2: | |||||||||
| City: | CRESWELL | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418952152 | ||||||||
| FaxNumber: | 5418952215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2012 | ||||||||
| LastUpdateDate: | 08/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 62736 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 208100000X | 9868PT | AZ | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.