MEDICARE: TALL FAMILY PHYSICAL THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1194667535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALL FAMILY PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	3630 S 25TH E STE 4
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-4993
Country	:	US
Telephone Number	:	208-970-4833
Fax Number	:	208-439-0986

Provider Business Practice Location Address
First Line	:	3630 S 25TH E STE 4
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-4993
Country	:	US
Telephone Number	:	208-970-4833
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ETHAN ALDON TALL
Credential	:	DPT
Telephone Number	:	208-970-4833

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	06/22/2026

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