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General NPI Number Information
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NPI Number | 1487515888
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Entity Type | Organization
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Legal Business Name | TKM LABS, LLC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 423 S WAKARA WAY
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-1242
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Country | US
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Telephone | 406-580-4641
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Fax |
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Provider Business Mailing Address
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Address Line | 703 BRIDGER DR STE B-3
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City | BOZEMAN
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State | MT
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Zip | 59715-2236
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Country | US
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Telephone | 406-580-4641
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | KOLE MICKOLIO
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Credential | DO
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Telephone | 406-580-4641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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