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NPI Code Detail

MEDICARE: JOANN PALMER KNIGHT BCTMB, CMMP, CPMT

MEDICARE:   JOANN PALMER KNIGHT  BCTMB, CMMP, CPMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist0019011170VA

General Provider Information

NPI Number : 1053789222
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANN PALMER KNIGHT BCTMB, CMMP, CPMT
Provider Business Mailing Address
First Line : 100 LARK CIR
Second Line :
City : NEWPORT NEWS
State : VA
Zip : 23601-2258
Country : US
Telephone Number : 757-591-0125
Fax Number : 757-591-0125
Provider Business Practice Location Address
First Line : 11719-B JEFFERSON AVE
Second Line : SUITE 106
City : NEWPORT NEWS
State : VA
Zip : 23606-2166
Country : US
Telephone Number : 757-591-0125
Fax Number : 757-591-0125
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2015
Last Update Date : 01/29/2016

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Directions to “ JOANN PALMER KNIGHT BCTMB, CMMP, CPMT” Practice Location

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