=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225134182
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTHA CROSS KNOX P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 245 NORTH ST
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24201-3274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-669-4711
-----------------------------------------------------
Fax | 276-669-0834
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 508 VANCE DR
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37620-4535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-764-2572
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2305002505
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------