Provider Demographics
NPI:1922334192
Name:KYNAST, KIM L (PT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:KYNAST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 STAR HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ABSAROKEE
Mailing Address - State:MT
Mailing Address - Zip Code:59001-6244
Mailing Address - Country:US
Mailing Address - Phone:406-328-4761
Mailing Address - Fax:406-328-4761
Practice Address - Street 1:52 STAR HAVEN DR
Practice Address - Street 2:
Practice Address - City:ABSAROKEE
Practice Address - State:MT
Practice Address - Zip Code:59001-6244
Practice Address - Country:US
Practice Address - Phone:406-328-4761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist