MEDICARE: MR. PHILIP W KLEM L.M.T

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	172M00000X	Mechanotherapist	33.009192	OH

General Provider Information

NPI Number	:	1538315627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP W KLEM L.M.T

Provider Business Mailing Address
First Line	:	8206 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6013
Country	:	US
Telephone Number	:	317-865-0162
Fax Number	:

Provider Business Practice Location Address
First Line	:	8206 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6013
Country	:	US
Telephone Number	:	317-865-0162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	08/08/2008

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