MEDICARE: KYLE ADAM CONATSER ORTHOPEDIC LMT

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	225700000X	Massage Therapist	3409	AL

General Provider Information

NPI Number	:	1033732748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE ADAM CONATSER ORTHOPEDIC LMT

Provider Business Mailing Address
First Line	:	220 ELBA HWY
Second Line	:
City	:	TROY
State	:	AL
Zip	:	36079-5000
Country	:	US
Telephone Number	:	334-430-8709
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 ELBA HWY
Second Line	:
City	:	TROY
State	:	AL
Zip	:	36079-5000
Country	:	US
Telephone Number	:	334-430-8709
Fax Number	:

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

Provider Enumeration Date	:	05/28/2020
Last Update Date	:	05/28/2020

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