Healthcare Provider Details

I. General information

NPI: 1366593212
Provider Name (Legal Business Name): PRINCIPAL KNOX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E CULVER RD
KNOX IN
46534-2216
US

IV. Provider business mailing address

103 POWELL CT SUITE 200
BRENTWOOD TN
37027-5079
US

V. Phone/Fax

Practice location:
  • Phone: 574-772-6231
  • Fax: 574-772-5948
Mailing address:
  • Phone: 615-372-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number09-005091-1
License Number StateIN

VIII. Authorized Official

Name: THOMAS M WEISS
Title or Position: PRESIDENT
Credential:
Phone: 615-372-8500