Healthcare Provider Details

I. General information

NPI: 1811071186
Provider Name (Legal Business Name): ANDREW KNOX PT COMT CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 NW GREENWOOD AVENUE
REDMOND OR
97756-1550
US

IV. Provider business mailing address

450 NW GREENWOOD AVENUE
REDMOND OR
97756-1550
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-0410
  • Fax: 541-923-7393
Mailing address:
  • Phone: 541-923-0410
  • Fax: 541-923-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3633
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: