Provider Demographics
NPI:1588142038
Name:BRENT S. KNIGHT - KNIGHT & ASSOCIATES PHYSICAL THERAPY
Entity type:Organization
Organization Name:BRENT S. KNIGHT - KNIGHT & ASSOCIATES PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:S
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OMPT
Authorized Official - Phone:315-265-7917
Mailing Address - Street 1:14 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3480
Mailing Address - Country:US
Mailing Address - Phone:315-265-7917
Mailing Address - Fax:315-265-5437
Practice Address - Street 1:14 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3480
Practice Address - Country:US
Practice Address - Phone:315-265-7917
Practice Address - Fax:315-265-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01466182Medicaid
NY02202720Medicaid
NY02602904Medicaid
NY02747735Medicaid
NY02202720Medicaid