Provider Demographics
NPI:1750869699
Name:KLOSTERMAN, TEAYRE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:TEAYRE
Middle Name:
Last Name:KLOSTERMAN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 7TH ST N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2410
Mailing Address - Country:US
Mailing Address - Phone:815-440-2792
Mailing Address - Fax:
Practice Address - Street 1:212 7TH ST N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2410
Practice Address - Country:US
Practice Address - Phone:815-440-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2255A2300XOtherATHLETIC TRAINER