Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jonathan Dac-Moang Liem, DPT

Individual provider Physical Therapist · NPI 1235903279

Jonathan Dac-Moang Liem, DPT is a Physical Therapist in Private Practice in Blackfoot, Idaho. Qualified in 2023, 3 years ago. Practices with Holisticare Physical Therapy, a 5-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
3
Licensed in
ID
In the registry since
2023
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

1441 Parkway Dr Ste 1
Blackfoot, ID 83221-1667
Phone: (208) 785-3446
Fax: (208) 980-7241
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT-8771 (ID)

Record details

NPI number1235903279
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedNovember 9, 2023
Last updated in NPPESNovember 9, 2023
Certification dateNovember 9, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Holisticare Physical Therapy — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Blackfoot