Provider Demographics
NPI:1053456020
Name:KNOWLES, WILLIAM J (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MIDDLE ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHITTENDEN
Mailing Address - State:VT
Mailing Address - Zip Code:05763
Mailing Address - Country:US
Mailing Address - Phone:802-483-2266
Mailing Address - Fax:
Practice Address - Street 1:3902 KILLINGTON RD
Practice Address - Street 2:
Practice Address - City:KILLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05751-0205
Practice Address - Country:US
Practice Address - Phone:802-422-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-00001102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer