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NPI Code Detail

MEDICARE: MRS. MICHELLE RAE KNIZNER ATC

MEDICARE: MRS. MICHELLE RAE KNIZNER ATC
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
1174400000XSpecialistIL

General Provider Information

NPI Number : 1386613255
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE RAE KNIZNER ATC
Provider Business Mailing Address
First Line : 313 PERSIMMON LN
Second Line :
City : OSWEGO
State : IL
Zip : 60543-8250
Country : US
Telephone Number : 630-551-0130
Fax Number :
Provider Business Practice Location Address
First Line : 300 W BUTTERFIELD RD
Second Line :
City : ELMHURST
State : IL
Zip : 60126-5017
Country : US
Telephone Number : 630-834-0478
Fax Number : 630-834-1677
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. MICHELLE RAE KNIZNER ATC” Practice Location

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