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General NPI Number Information
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NPI Number | 1154675486
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Entity Type | Individual
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Provider Name | BRANDY KNEPP PTA
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Gender | Female
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 1712 N LELAND DR
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City | HUNTINGBURG
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State | IN
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Zip | 47542-9348
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Country | US
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Telephone | 812-683-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 12910 E 75 N
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City | LOOGOOTEE
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State | IN
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Zip | 47553-5201
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Country | US
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Telephone | 812-486-5745
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06003559A
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License Number State | IN
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