Provider Demographics
NPI:1992921704
Name:KNIGHT, GEORGE JUSTIN (MPT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:JUSTIN
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 S MAIN ST
Mailing Address - Street 2:P.O. BOX 1008
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-2875
Mailing Address - Country:US
Mailing Address - Phone:918-689-3030
Mailing Address - Fax:918-689-2525
Practice Address - Street 1:137 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-2875
Practice Address - Country:US
Practice Address - Phone:918-689-3030
Practice Address - Fax:918-689-2525
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist