Organization
208 PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYREL NELSON PT, DPT (OWNER)
(208) 201-0365
Entity
Organization
Contact information
Practice address
1120 STOCKS AVE STE C, REXBURG, ID 83440-3590
(208) 261-2123
Mailing address
1940 S BONITO WAY STE 190, MERIDIAN, ID 83642-5618
(208) 287-9420
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477045581
MEDICARE
ID
Enumeration date
10/06/2022
Last updated
02/22/2023
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