Provider Demographics
NPI:1073915765
Name:KNIGHT, ANNA BROOKE (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:BROOKE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9929 SPID DR
Mailing Address - Street 2:SUITE #113
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5105
Mailing Address - Country:US
Mailing Address - Phone:361-937-5508
Mailing Address - Fax:
Practice Address - Street 1:9929 SPID DR
Practice Address - Street 2:SUITE #113
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-5105
Practice Address - Country:US
Practice Address - Phone:361-937-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT118911225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist