# KJT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Black Mountain Wellness
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114800562
- **Authorized official:** KATI JO TUMA MMS, PA-C (OWNER)
- **Authorized official phone:** (307) 267-6150

## Contact information

- **Practice address:** 1314 SHUROS DR, FAIRBANKS, AK 99709-6740
- **Practice address phone:** (307) 267-6150
- **Practice address fax:** (833) 986-3605
- **Mailing address:** 560 GRANITE PEAK DR APT 102, CASPER, WY 82609-4522
- **Mailing address phone:** (307) 267-6150
- **Mailing address fax:** (833) 986-3605

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | NULL | — |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |
| 261QP3300X | Pain Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 07/30/2025
- **Last updated:** 07/30/2025