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General NPI Number Information
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NPI Number | 1124264478
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Entity Type | Individual
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Provider Name | THERESA ANN KNOLL MPT
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Gender | Female
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 3475 S ALPINE RD PHYSICIANS IMMEDIATE CARE
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City | ROCKFORD
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State | IL
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Zip | 61109-2604
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Country | US
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Telephone | 815-874-8000
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Fax | 815-874-7525
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Provider Business Mailing Address
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Address Line | 210 SE PIONEER WAY STE 2
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City | OAK HARBOR
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State | WA
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Zip | 98277-5705
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Country | US
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Telephone | 360-679-8600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8149
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070017118
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60736405
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License Number State | WA
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