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NPI Code Detail

MEDICARE: CARLIE KNUTH

MEDICARE: CARLIE KNUTH
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
1225200000XPhysical Therapy AssistantCP048540AGA

General Provider Information

NPI Number : 1073498606
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLIE KNUTH
Provider Business Mailing Address
First Line : 33900 HARPER AVE STE 104
Second Line :
City : CLINTON TWP
State : MI
Zip : 48035-4258
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2836 LAVISTA RD STE 1B
Second Line :
City : DECATUR
State : GA
Zip : 30033-1300
Country : US
Telephone Number : 678-894-4410
Fax Number : 678-894-4409
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2025
Last Update Date : 10/29/2025

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Directions to “ CARLIE KNUTH ” Practice Location

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