MEDICARE: TANYA T KERN 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	124	MT

General Provider Information

NPI Number	:	1154747178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA T KERN LMT

Provider Business Mailing Address
First Line	:	PO BOX 1542
Second Line	:
City	:	TROUT CREEK
State	:	MT
Zip	:	59874-1542
Country	:	US
Telephone Number	:	406-827-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 VINSON MILL ROAD
Second Line	:
City	:	TROUT CREEK
State	:	MT
Zip	:	59874-1542
Country	:	US
Telephone Number	:	406-827-6000
Fax Number	:

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

Provider Enumeration Date	:	03/14/2014
Last Update Date	:	03/14/2014

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Directions to “ TANYA T KERN LMT” Practice Location

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