Provider Demographics
NPI:1972121895
Name:GARIFI, KEVIN JAMES (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:GARIFI
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 AMERICAN WAY APT 108
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1792
Mailing Address - Country:US
Mailing Address - Phone:661-755-6166
Mailing Address - Fax:
Practice Address - Street 1:2360 MULLAN ROAD SUITE C
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-0003
Practice Address - Country:US
Practice Address - Phone:661-755-6166
Practice Address - Fax:406-721-6053
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTATR-LAT-LIC-25092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty