Provider Demographics
NPI:1003962382
Name:KNOX, MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:KNOX
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SUNSET AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4567
Mailing Address - Country:US
Mailing Address - Phone:732-502-8850
Mailing Address - Fax:732-502-3199
Practice Address - Street 1:3200 SUNSET AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4567
Practice Address - Country:US
Practice Address - Phone:732-502-8850
Practice Address - Fax:732-502-3199
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA007606002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ060186TLVMedicare ID - Type UnspecifiedIDENTIFICATION NUMBER