Healthcare Provider Details

I. General information

NPI: 1114073905
Provider Name (Legal Business Name): B.A. KNOTT PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4912 W MARSHALL ST SUITE 101
RICHMOND VA
23230-3127
US

IV. Provider business mailing address

4912 W MARSHALL ST SUITE 101
RICHMOND VA
23230-3127
US

V. Phone/Fax

Practice location:
  • Phone: 804-355-4773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateVA

VIII. Authorized Official

Name: STEVEN F SHIELDS
Title or Position: BILLING MANAGER
Credential:
Phone: 804-282-9133