NPI Code Detail JSON Logo

1114800562 NPI number — KJT, LLC

NPI Number: 1114800562
Health Care Provider/Practitioner: KJT, LLC

Information about “1114800562” NPI (KJT, LLC) exists in 1114800562 in HTML format HTML  |  1114800562 in plain Text format TXT  |  1114800562 in PDF (Portable Document Format) PDF  |  1114800562 in an XML format XML  formats.

NPI Number : 1114800562 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114800562",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "KJT, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "560 GRANITE PEAK DR APT 102",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CASPER",
    "MailingAddressStateName": "WY",
    "MailingAddressPostalCode": "82609-4522",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "307-267-6150",
    "MailingAddressFaxNumber": "833-986-3605",
    "FirstLinePracticeLocationAddress": "1314 SHUROS DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAIRBANKS",
    "PracticeLocationAddressStateName": "AK",
    "PracticeLocationAddressPostalCode": "99709-6740",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "307-267-6150",
    "PracticeLocationAddressFaxNumber": "833-986-3605",
    "EnumerationDate": "07/30/2025",
    "LastUpdateDate": "07/30/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TUMA",
    "AuthorizedOfficialFirstName": "KATI",
    "AuthorizedOfficialMiddleName": "JO",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MMS, PA-C",
    "AuthorizedOfficialTelephoneNumber": "307-267-6150",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "204C00000X",
          "TaxonomyName": "Sports Medicine (Neuromusculoskeletal Medicine) Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261Q00000X",
          "TaxonomyName": "Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QH0100X",
          "TaxonomyName": "Health Service Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QP2000X",
          "TaxonomyName": "Physical Therapy Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QP3300X",
          "TaxonomyName": "Pain Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM1300X",
          "TaxonomyName": "Multi-Specialty Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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