| Doctor Name: | TYLER J BLACKWELDER |
| NPI Number: | 1346421021 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.T |
| License Number: | PT-2507 |
| Business Practice Address: | 8332 North Wayne Drive Hayden, ID - 838355037 |
| Business Phone Number: | 2087580484 |
| Business Fax Number: | 2084854781 |
| Mailing Address: | Po Box 3482, POST FALLS |
| State: | ID |
| Postal Code: | 838773482 |
| Phone Number: | 2082096170 |
| Fax Number: | 2082096169 |
| NPI Enumeration Date: | 11/21/2007 |
| NPI Last Update Date: | 04/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT-2507 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |