Healthcare Provider Details

I. General information

NPI: 1003968173
Provider Name (Legal Business Name): MARIA P KNIGHT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W MAPLE AVE
MERCHANTVILLE NJ
08109
US

IV. Provider business mailing address

107 W MAPLE AVE
MERCHANTVILLE NJ
08109-2038
US

V. Phone/Fax

Practice location:
  • Phone: 856-910-0495
  • Fax: 856-910-0193
Mailing address:
  • Phone: 856-910-0495
  • Fax: 856-665-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00362900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: