Healthcare Provider Details

I. General information

NPI: 1326766189
Provider Name (Legal Business Name): KENDALL HANNAH KNOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-3733
US

IV. Provider business mailing address

4118 SKY RANCH DR
GLENWOOD SPRINGS CO
81601-9287
US

V. Phone/Fax

Practice location:
  • Phone: 719-255-8227
  • Fax:
Mailing address:
  • Phone: 970-618-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: