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NPI Code Detail

MEDICARE: ALYSSA MEGAN KLOS DPT

MEDICARE: ALYSSA MEGAN KLOS DPT
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
1225100000XPhysical TherapistCP015215TAZ
2225100000XPhysical Therapist11153RLA
3225100000XPhysical Therapist38317FL

General Provider Information

NPI Number : 1932823366
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA MEGAN KLOS DPT
Provider Business Mailing Address
First Line : PO BOX 649
Second Line :
City : FORT DEFIANCE
State : AZ
Zip : 86504-0649
Country : US
Telephone Number : 928-729-8000
Fax Number :
Provider Business Practice Location Address
First Line : CORNER OF ROUTE N12 AND N7
Second Line :
City : FORT DEFIANCE
State : AZ
Zip : 86504
Country : US
Telephone Number : 928-729-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2022
Last Update Date : 03/10/2026

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Directions to “ ALYSSA MEGAN KLOS DPT” Practice Location

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