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General NPI Number Information
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NPI Number | 1376029900
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Entity Type | Individual
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Provider Name | KARL KNUTSSON
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Gender | Male
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 200 N 5TH ST
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City | GREENFIELD
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State | OH
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Zip | 45123-1373
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Country | US
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Telephone | 740-656-8223
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Fax |
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Provider Business Mailing Address
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Address Line | 1312 RIDGE RD
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City | WILMINGTON
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State | OH
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Zip | 45177-2585
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Country | US
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Telephone | 304-917-1335
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT005651
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License Number State | OH
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