Provider Demographics
NPI:1215210026
Name:KNOTT, GINA KATHLEEN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:KATHLEEN
Last Name:KNOTT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 SHENK RD
Mailing Address - Street 2:
Mailing Address - City:ELIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-9440
Mailing Address - Country:US
Mailing Address - Phone:567-204-1207
Mailing Address - Fax:
Practice Address - Street 1:485 MOXIE LN
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-9182
Practice Address - Country:US
Practice Address - Phone:419-692-3405
Practice Address - Fax:419-692-3400
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist