Healthcare Provider Details

I. General information

NPI: 1962996033
Provider Name (Legal Business Name): KEITH ALAN KNURR DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 SCIENCE DR
MADISON WI
53711-1074
US

IV. Provider business mailing address

8430 MARKET ST APT 312
MIDDLETON WI
53562-4782
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-8303
  • Fax:
Mailing address:
  • Phone: 262-210-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number14157-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: