Provider Demographics
NPI:1386773018
Name:KNIGHT, JEFFREY MICHEAL (PT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHEAL
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 1:166 INTERLOCHEN DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3354
Mailing Address - Country:US
Mailing Address - Phone:504-432-2419
Mailing Address - Fax:770-629-1202
Practice Address - Street 1:166 INTERLOCHEN DR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3354
Practice Address - Country:US
Practice Address - Phone:504-432-2419
Practice Address - Fax:770-629-1202
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist