Individual
DR. TYLER J BLACKWELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
827 W PRAIRIE AVE, HAYDEN, ID 83835-8459
(208) 819-8486
(208) 561-7242
Mailing address
827 W PRAIRIE AVE, HAYDEN, ID 83835-8459
(208) 758-0484
(208) 561-7242
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2507
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008105
—
ID
01
—
1652803
MEDICARE PROVIDER NUMBER
ID
Enumeration date
11/21/2007
Last updated
05/13/2024
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