MEDICARE: ROBERTA B KNOTT PA

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
1	363A00000X	Physician Assistant	1443	CO

General Provider Information

NPI Number	:	1467458117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA B KNOTT PA

Provider Business Mailing Address
First Line	:	13772 DENVER WEST PKWY
Second Line	:	STE 250
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3196
Country	:	US
Telephone Number	:	303-216-0333
Fax Number	:	303-216-1511

Provider Business Practice Location Address
First Line	:	13772 DENVER WEST PKWY
Second Line	:	STE 250
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3196
Country	:	US
Telephone Number	:	303-216-0333
Fax Number	:	303-216-1511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	10/15/2007

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