Active NPI
Tyler Haskell, DPT
- Pediatric Physical Therapist
- Meridian, ID
National Provider Identifier
1669927000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- PT-4640
- Practice address
- 1967 N Cairns Way
Meridian, ID 83646-1360 - Phone
- (208) 406-1968
- NPI assigned
- Aug 15, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT-4640 | ID | |
| Physical Therapist | 225100000X | PT4640 | ID | |
| Pediatric Physical Therapist | 2251P0200X | PT-4640 | ID | Primary |
Addresses
Primary practice location
1967 N Cairns Way
Meridian, ID 83646-1360
Mailing address
12072 W McMillan Rd
Boise, ID 83713-2462
Phone (208) 939-0533
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260316003397 | ID | Order and Referring Only - Physical Therapist in Private Practice | 2567776883 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-4640 | ID | MD | Physical Therapist |
| PT4640 | ID | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771286400000",
"number": "1669927000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12072 W MCMILLAN RD",
"city": "BOISE",
"state": "ID",
"postal_code": "837132462",
"telephone_number": "208-939-0533",
"fax_number": "208-939-3341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1967 N CAIRNS WAY",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836461360",
"telephone_number": "208-406-1968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HASKELL",
"first_name": "TYLER",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-15",
"last_updated": "2026-02-17",
"certification_date": "2026-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT-4640",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT4640",
"primary": false
},
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "ID",
"license": "PT-4640",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2026; 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.