Healthcare Provider Details

I. General information

NPI: 1922211960
Provider Name (Legal Business Name): KRIS M KNAPP A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 SHELBY-ONT. RD
MANSFIELD OH
44906
US

IV. Provider business mailing address

PO BOX 32
ONTARIO OH
44862-0032
US

V. Phone/Fax

Practice location:
  • Phone: 419-529-3969
  • Fax: 419-529-5649
Mailing address:
  • Phone: 419-529-3969
  • Fax: 419-529-5649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT0485
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: