NPIMap

Organization Active NPI

Physioone

  • Physical Therapist
  • Hayden, ID
National Provider Identifier
1659642775
Registry record updated Sep 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PHYSIOONE
Practice address
8827 N Government Way Unit 106
Hayden, ID 83835-8231
Phone
(208) 758-0484
Fax
(208) 485-4781
NPI assigned
Jan 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tyler J Blackwelder, DPTNPI 1346421021
Title
Owner
Phone
(208) 758-0484

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

8827 N Government Way Unit 106
Hayden, ID 83835-8231

Mailing address

PO Box 2834
Hayden, ID 83835-2834
Phone (208) 818-9263

Other practice location 1

8382 N Wayne Dr
Hayden, ID 83835-6028
Phone (208) 818-9263

Other identifiers 1

IdentifierTypeStateIssuer
IDTPID008105MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121010000381 ID Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5395994107 Receives reassigned benefits from 1 practitioner
Practice locations: Hayden, ID

National Provider Directory

National Provider Directory

Locations

8827 N Government Way
Unit 106
Hayden, ID 83835
Phone (208) 518-1168

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600646400000",
    "number": "1659642775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2834",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838352834",
            "telephone_number": "208-818-9263",
            "fax_number": "208-485-4781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8827 N GOVERNMENT WAY UNIT 106",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838358231",
            "telephone_number": "208-758-0484",
            "fax_number": "208-485-4781"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8382 N Wayne Dr",
            "address_purpose": "LOCATION",
            "city": "Hayden",
            "state": "ID",
            "postal_code": "838356028",
            "country_code": "US",
            "telephone_number": "208-818-9263",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHYSIOONE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-20",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A",
        "authorized_official_last_name": "BLACKWELDER",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-758-0484",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "IDTPID008105",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayden, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.