Provider Demographics
NPI:1114397569
Name:KNUTSON, KARA LYNN (LAT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LYNN
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 FM 2751
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7209
Mailing Address - Country:US
Mailing Address - Phone:903-746-7484
Mailing Address - Fax:
Practice Address - Street 1:2770 FM 2751
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7209
Practice Address - Country:US
Practice Address - Phone:903-746-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT49592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer