Provider Demographics
NPI:1699084913
Name:KNELL, PAUL JAMES (PTA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JAMES
Last Name:KNELL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 WABASH ST
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-2066
Mailing Address - Country:US
Mailing Address - Phone:260-589-8346
Mailing Address - Fax:
Practice Address - Street 1:604 RENNAKER ST
Practice Address - Street 2:
Practice Address - City:LA FONTAINE
Practice Address - State:IN
Practice Address - Zip Code:46940-9045
Practice Address - Country:US
Practice Address - Phone:765-663-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004154A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant