=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750852018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN KNAUSS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2018
-----------------------------------------------------
Last Update Date | 12/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 MAGNOLIA ST
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21601-3657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-763-6823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4750 EVERLEA CT
-----------------------------------------------------
City | PRESTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21655-1569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | A3070
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------