Provider Demographics
NPI:1316999360
Name:KNIGHT, LISA ANNE (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:412 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-6922
Mailing Address - Country:US
Mailing Address - Phone:405-273-1523
Mailing Address - Fax:405-273-1743
Practice Address - Street 1:412 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6922
Practice Address - Country:US
Practice Address - Phone:405-273-1523
Practice Address - Fax:405-273-1743
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3498225100000X
OK5071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS141082OtherBCBS OF KS
KS36939011OtherBCBS OF KC
KS141082OtherBCBS OF KS