Organization
PHYSIOONE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER J BLACKWELDER DPT (OWNER)
(208) 758-0484
Entity
Organization
Contact information
Practice address
8827 N GOVERNMENT WAY UNIT 106, HAYDEN, ID 83835-8231
(208) 758-0484
(208) 485-4781
Mailing address
PO BOX 2834, HAYDEN, ID 83835-2834
(208) 818-9263
(208) 485-4781
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IDTPID008105
—
ID
Enumeration date
01/20/2012
Last updated
09/21/2020
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