MEDICARE: KATHLEEN KNOWLTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	06003819A	IN

General Provider Information

NPI Number	:	1215579271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN KNOWLTON

Provider Business Mailing Address
First Line	:	62603 REDWOOD RD
Second Line	:
City	:	NORTH LIBERTY
State	:	IN
Zip	:	46554-9743
Country	:	US
Telephone Number	:	574-656-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	62603 REDWOOD RD
Second Line	:
City	:	NORTH LIBERTY
State	:	IN
Zip	:	46554-9743
Country	:	US
Telephone Number	:	574-655-8282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	10/11/2019

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Directions to “ KATHLEEN KNOWLTON ” Practice Location

Language	Start Address	Practice Location

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