Healthcare Provider Details

I. General information

NPI: 1265871511
Provider Name (Legal Business Name): BRETT KNIGHT MS, AT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 W SUPERIOR ST
ALMA MI
48801-1504
US

IV. Provider business mailing address

8395 MONROE RD
ELWELL MI
48832-9708
US

V. Phone/Fax

Practice location:
  • Phone: 989-463-7288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2601000910
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: