Provider Demographics
NPI:1902627409
Name:FOX, TYSON JADE (DPT)
Entity type:Individual
Prefix:
First Name:TYSON
Middle Name:JADE
Last Name:FOX
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 W RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-6254
Mailing Address - Country:US
Mailing Address - Phone:208-813-9544
Mailing Address - Fax:208-810-4499
Practice Address - Street 1:7711 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-6254
Practice Address - Country:US
Practice Address - Phone:208-813-9544
Practice Address - Fax:208-810-4499
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist