Healthcare Provider Details

I. General information

NPI: 1922665322
Provider Name (Legal Business Name): KNYTEC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9814 SOMERSET WIND DR APT 204
RIVERVIEW FL
33578-5535
US

IV. Provider business mailing address

PO BOX 8503
TAMPA FL
33674-8503
US

V. Phone/Fax

Practice location:
  • Phone: 813-317-6802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: LASHONDA KNIGHT
Title or Position: PRESIDENT, CEO
Credential:
Phone: 813-317-6802