Physioone
NPI 1659642775ActiveOrganization· Physical Therapist· Hayden, ID
Physical Therapist in Hayden, Idaho, registered in NPPES in January 2012. The authorized official on file is Tyler J. Blackwelder, DPT, Owner. Enrolled in Medicare as part b supplier - physical/occupational therapy group in private practice.
Overview
| NPI | 1659642775 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 20, 2012 |
| Last updated in NPPES | Sep 21, 2020 |
| Certified by provider | Sep 21, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Physical/Occupational Therapy Group in Private Practice (ID) |
|---|
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