MEDICARE: TALYN KLEWENO LAT, ACT

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	2255A2300X	Athletic Trainer	24-01585	KS
2	225100000X	Physical Therapist	11-07660	KS

General Provider Information

NPI Number	:	1770079634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALYN KLEWENO LAT, ACT

Provider Business Mailing Address
First Line	:	1333 MEADOWLARK LN STE 104
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-1200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 MEADOWLARK LN
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-1249
Country	:	US
Telephone Number	:	913-287-8815
Fax Number	:

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

Provider Enumeration Date	:	07/03/2018
Last Update Date	:	08/26/2025

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Directions to “ TALYN KLEWENO LAT, ACT” Practice Location

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