Provider Demographics
NPI:1124082433
Name:KNAPP PROSTHETICS
Entity type:Organization
Organization Name:KNAPP PROSTHETICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:LCPO
Authorized Official - Phone:360-486-0565
Mailing Address - Street 1:530 LILLY RD SE
Mailing Address - Street 2:#100
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2111
Mailing Address - Country:US
Mailing Address - Phone:360-486-0565
Mailing Address - Fax:360-486-0551
Practice Address - Street 1:530 LILLY RD SE
Practice Address - Street 2:#100
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2111
Practice Address - Country:US
Practice Address - Phone:360-486-0565
Practice Address - Fax:360-486-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS00000379335E00000X
WAOI00000186335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA188631OtherLABOR & INDUSTRIES
WA9055971Medicaid
WA1255SOOtherREGENCE BLUE SHIELD
WA188631OtherLABOR & INDUSTRIES
5351730001Medicare NSC