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General NPI Number Information
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NPI Number | 1225533276
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Entity Type | Individual
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Provider Name | NICOLE L KNOTT
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Gender | Female
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 3 PURSUIT
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City | ALISO VIEJO
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State | CA
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Zip | 92656-4213
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Country | US
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Telephone | 949-389-8516
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Fax |
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Provider Business Mailing Address
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Address Line | 114 W AVENIDA CADIZ
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4246
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Country | US
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Telephone | 949-630-8514
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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 | 8894
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License Number State | CA
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