Provider Demographics
NPI:1992571509
Name:KNIGHT, LYNHOLLY
Entity type:Individual
Prefix:
First Name:LYNHOLLY
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3649 EVERGREEN PKWY UNIT 1534
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80437-4660
Mailing Address - Country:US
Mailing Address - Phone:720-525-6281
Mailing Address - Fax:
Practice Address - Street 1:28577 BUFFALO PARK RD STE 230
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7306
Practice Address - Country:US
Practice Address - Phone:720-525-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0026031225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist