Healthcare Provider Details

I. General information

NPI: 1497897458
Provider Name (Legal Business Name): JODY BOYD RAWLINGS P. T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 N 2ND EAST
REXBURG ID
83440-1621
US

IV. Provider business mailing address

217 N 2ND E
REXBURG ID
83440-1621
US

V. Phone/Fax

Practice location:
  • Phone: 208-359-6127
  • Fax: 208-359-9479
Mailing address:
  • Phone: 208-359-6127
  • Fax: 208-359-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1346
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: