Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 013547-1 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 013547-1 |
NPI | 1972667533 |
---|---|
Provider Name | Mr. Brent S. Knight |
First Address | Potsdam, NY 13676-3480 |
Second Address | Potsdam, NY 13676-3480 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 09/06/2008 |