Healthcare Provider Details

I. General information

NPI: 1558635185
Provider Name (Legal Business Name): CORINNE KNIGHT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORINNE SHUMAKER DPT

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7560 GARDNER PARK DR
GAINESVILLE VA
20155-3414
US

IV. Provider business mailing address

7560 GARDNER PARK DR
GAINESVILLE VA
20155-3414
US

V. Phone/Fax

Practice location:
  • Phone: 703-753-1005
  • Fax: 703-753-2207
Mailing address:
  • Phone: 703-753-1005
  • Fax: 703-753-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206711
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: