Physio Shop Idaho LLC
NPI 1750242889ActiveOrganization· Physical Therapist· Idaho Falls, ID
Physical Therapist in Idaho Falls, Idaho, registered in NPPES in November 2025. The authorized official on file is Tyler L. Johnson, PT, DPT, Physical Therapist. Enrolled in Medicare as part b supplier - physical/occupational therapy group in private practice.
Overview
| NPI | 1750242889 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Nov 19, 2025 |
| Last updated in NPPES | Nov 19, 2025 |
| Certified by provider | Nov 6, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 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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