=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457361453
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRED KNIGHT DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2006
-----------------------------------------------------
Last Update Date | 03/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 HIGH MOUNTAIN RD
-----------------------------------------------------
City | NORTH HALEDON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07508-2665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-636-2732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 468 PARISH DR SUITE 6
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07470-4671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-636-2732
-----------------------------------------------------
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------