Healthcare Provider Details

I. General information

NPI: 1336507383
Provider Name (Legal Business Name): ZANE KNIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 INDUSTRIAL BLVD STE 550H
WEST SACRAMENTO CA
95691-6516
US

IV. Provider business mailing address

PO BOX 9102
SOUTH LAKE TAHOE CA
96158-2102
US

V. Phone/Fax

Practice location:
  • Phone: 916-373-7575
  • Fax: 916-373-1555
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number43545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: