=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114372844
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYAN MICHAEL KNIGHT MS, ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2016
-----------------------------------------------------
Last Update Date | 05/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1680 ZION RD
-----------------------------------------------------
City | BELLEFONTE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16823-9141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-355-8660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 371 LOWER COLEVILLE RD
-----------------------------------------------------
City | BELLEFONTE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16823-8727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-414-1194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | RT005700
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------