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General NPI Number Information
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NPI Number | 1306755517
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Entity Type | Organization
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Legal Business Name | THE HEALTHY PLACE PLLC
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 3158 NORTH CLANTON ST
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City | BUCKEYE
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State | AZ
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Zip | 85396
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Country | US
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Telephone | 208-848-4987
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Fax | 602-563-8218
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Provider Business Mailing Address
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Address Line | 784 S CLEARWATER LOOP # 4507
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City | POST FALLS
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State | ID
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Zip | 83854-9599
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Country | US
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Telephone | 208-848-4987
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Fax | 602-563-8218
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | TYLER ANDERSON
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Credential |
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Telephone | 586-612-0476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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