Provider Demographics
NPI:1164489738
Name:KNIGHT, DEMIAN M (PT)
Entity Type:Individual
Prefix:
First Name:DEMIAN
Middle Name:M
Last Name:KNIGHT
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 1:1398 WEIMER RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:575-737-0304
Mailing Address - Fax:575-737-9445
Practice Address - Street 1:1398 WEIMER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:575-737-0304
Practice Address - Fax:575-737-9445
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-04-18
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2016-04-18
Provider Licenses
StateLicense IDTaxonomies
NM4783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist