Individual
SAMUEL WAT TYLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
703 S AMERICANA BLVD STE 130, BOISE, ID 83702-6754
(208) 706-7530
Mailing address
3016 S GEKELER LN, BOISE, ID 83706-5201
(720) 557-1636
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-6569
ID
Other
Enumeration date
01/08/2020
Last updated
01/08/2020
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