Provider Demographics
NPI:1194153627
Name:KNOX, TIMOTHY J (PT, CHT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:KNOX
Suffix:
Gender:M
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3651
Mailing Address - Country:US
Mailing Address - Phone:314-368-0098
Mailing Address - Fax:314-962-3199
Practice Address - Street 1:1700 WALNUT ST
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-3100
Practice Address - Country:US
Practice Address - Phone:618-452-2111
Practice Address - Fax:618-225-6417
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORO684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist