Provider Demographics
NPI:1417100850
Name:KNIGHT, LISA M (LMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6172 STORNOWAY DR S
Mailing Address - Street 2:APT. A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2172
Mailing Address - Country:US
Mailing Address - Phone:614-861-5210
Mailing Address - Fax:
Practice Address - Street 1:99 N BRICE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-6510
Practice Address - Country:US
Practice Address - Phone:614-522-8010
Practice Address - Fax:614-522-8011
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.014913172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist