MEDICARE: MRS. KAY E HUMPHRIES SLP

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	261QP2000X	Physical Therapy Clinic/Center	370	AK

General Provider Information

NPI Number	:	1225316805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAY E HUMPHRIES SLP

Provider Business Mailing Address
First Line	:	11901 BUSINESS BLVD
Second Line	:	SUITE 209
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7701
Country	:	US
Telephone Number	:	907-694-6002
Fax Number	:	907-694-6015

Provider Business Practice Location Address
First Line	:	11901 BUSINESS BLVD
Second Line	:	SUITE 209
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7701
Country	:	US
Telephone Number	:	907-694-6002
Fax Number	:	907-694-6015

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

Provider Enumeration Date	:	07/29/2011
Last Update Date	:	07/29/2011

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