Physio Shop Idaho LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PHYSIO SHOP IDAHO LLC

Practice address

2283 E 17TH St
Idaho Falls, ID 83404

Phone

(208) 317-1736

NPI assigned

Nov 19, 2025

Organization subpart

No

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

Authorized official

Name

Tyler L Johnson, PT, DPTNPI 1285443820

Title

Physical Therapist

Phone

(208) 317-1736

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 2

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

• Tyler L Johnson, DPT

  • Physical Therapist
  • Idaho Falls, ID
  • NPI 1285443820
  Medicare reassignment NPD Authorized official
• Jason Christopher Dorsch, P.T., A.T.C.

  • Physical Therapist
  • Flagstaff, AZ
  • NPI 1023328804
  NPD

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

{
    "created_epoch": "1763510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763510400000",
    "number": "1750242889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2283 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-317-1736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2283 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-317-1736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSIO SHOP IDAHO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-19",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-06",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "208-317-1736",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriel Phillips, PHARMD
• Renee Phillips
• Taylor Mark Phillips
• Physician Skin Care
• Physician's Choice Cardiology, PLLC
• Claudia Isabel Picazzo, AMFT
• Amber Pichinte
• Pick PT Ammon LLC (Pick PT)
• Pick PT Physical Therapy Idaho Falls (Pick PT Idaho Falls)
• Pick PT Physical Therapy LLC

• Physical Therapist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; 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.