Provider Demographics
NPI:1194970822
Name:KNIGHT, COAN ALAN (PT)
Entity type:Individual
Prefix:MR
First Name:COAN
Middle Name:ALAN
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71049-2318
Mailing Address - Country:US
Mailing Address - Phone:318-465-3391
Mailing Address - Fax:
Practice Address - Street 1:8961 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-3001
Practice Address - Country:US
Practice Address - Phone:318-671-8772
Practice Address - Fax:318-671-8776
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1976792Medicaid