Provider Demographics
NPI:1114800562
Name:KJT, LLC
Entity type:Organization
Organization Name:KJT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:TUMA
Authorized Official - Suffix:
Authorized Official - Credentials:MMS, PA-C
Authorized Official - Phone:307-267-6150
Mailing Address - Street 1:560 GRANITE PEAK DR APT 102
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4522
Mailing Address - Country:US
Mailing Address - Phone:307-267-6150
Mailing Address - Fax:833-986-3605
Practice Address - Street 1:1314 SHUROS DR
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-6740
Practice Address - Country:US
Practice Address - Phone:307-267-6150
Practice Address - Fax:833-986-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain