Individual
JASON RAY HYDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
725 JENSEN GROVE DR, SUITE 4, BLACKFOOT, ID 83221-1636
(208) 227-6255
Mailing address
PO BOX 730, BLACKFOOT, ID 83221-0730
(208) 227-6255
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1987
ID
Other
Enumeration date
04/15/2010
Last updated
03/21/2013
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