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NPI Code Detail

MEDICARE: CARYN KOHLRUST ATC, LAT

MEDICARE: CARYN KOHLRUST ATC, LAT
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
12255A2300XAthletic Trainer524NM

General Provider Information

NPI Number : 1588936223
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARYN KOHLRUST ATC, LAT
Provider Business Mailing Address
First Line : 465 SALOPEK BLVD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-7608
Country : US
Telephone Number : 505-412-5112
Fax Number :
Provider Business Practice Location Address
First Line : 1955 N VALLEY DR
Second Line :
City : LAS CRUCES
State : NM
Zip : 88007-5154
Country : US
Telephone Number : 505-412-5112
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2012
Last Update Date : 01/26/2012

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Directions to “ CARYN KOHLRUST ATC, LAT” Practice Location

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