MEDICARE: ALISA J KNOP P.T.

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	225100000X	Physical Therapist	PT1715	ME

General Provider Information

NPI Number	:	1790023661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA J KNOP P.T.

Provider Business Mailing Address
First Line	:	40 MAPLE ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-4553
Country	:	US
Telephone Number	:	207-899-1922
Fax Number	:	207-899-1923

Provider Business Practice Location Address
First Line	:	40 MAPLE ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-4553
Country	:	US
Telephone Number	:	207-899-1922
Fax Number	:	207-899-1923

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

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2013

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