Provider Demographics
NPI:1053938449
Name:DR TARYN KILTY LLC
Entity type:Organization
Organization Name:DR TARYN KILTY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KILTY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:307-630-0740
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:WY
Mailing Address - Zip Code:82221-0088
Mailing Address - Country:US
Mailing Address - Phone:307-630-0740
Mailing Address - Fax:307-222-6208
Practice Address - Street 1:1913 MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-2722
Practice Address - Country:US
Practice Address - Phone:307-630-0740
Practice Address - Fax:307-222-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty