Individual
TYLER L JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2283 E 17TH ST, IDAHO FALLS, ID 83404
(208) 710-7799
Mailing address
2283 E 17TH ST, IDAHO FALLS, ID 83404
(208) 710-7799
(208) 717-0949
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7571087
ID
261QP2000X
Physical Therapy Clinic/Center
Primary
033975
AZ
261QP2000X
Physical Therapy Clinic/Center
Primary
7571087
ID
Other
Enumeration date
01/07/2025
Last updated
04/24/2026
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