Provider Demographics
NPI:1396034088
Name:KNIGHT, HEATHER S (PTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2160
Mailing Address - Country:US
Mailing Address - Phone:603-738-5336
Mailing Address - Fax:
Practice Address - Street 1:184 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1799
Practice Address - Country:US
Practice Address - Phone:508-238-7053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8448225200000X
NH0758225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant