Provider Demographics
NPI:1275032674
Name:KNORR, ANNA (DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KNORR
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:PO BOX 1888
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-1888
Mailing Address - Country:US
Mailing Address - Phone:541-536-6122
Mailing Address - Fax:541-536-6123
Practice Address - Street 1:51681 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-9626
Practice Address - Country:US
Practice Address - Phone:541-536-6122
Practice Address - Fax:541-536-6123
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62620261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
62620Other931050246
62620Other931050246