Provider Demographics
NPI:1316336126
Name:KNIGHT, TIFFANY ELLIS (LAT, ATC, OTC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ELLIS
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LAT, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 LIVINGSTON CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:DELCO
Mailing Address - State:NC
Mailing Address - Zip Code:28436-9626
Mailing Address - Country:US
Mailing Address - Phone:910-617-1094
Mailing Address - Fax:
Practice Address - Street 1:2700 N COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-8816
Practice Address - Country:US
Practice Address - Phone:910-350-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZX2200X
NCLAT-36292255A2300X
SC15752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant