Provider Demographics
NPI:1033233440
Name:KNODEL, BOBBY JOE (MS ATC)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:JOE
Last Name:KNODEL
Suffix:
Gender:M
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4143 52ND ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4251
Mailing Address - Country:US
Mailing Address - Phone:701-367-2785
Mailing Address - Fax:701-231-5189
Practice Address - Street 1:N UNIVERSITY DR AT 17TH AVE N
Practice Address - Street 2:BISON SPORTS ARENA
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58105
Practice Address - Country:US
Practice Address - Phone:701-231-6492
Practice Address - Fax:701-231-5189
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND286-042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer