Provider Demographics
NPI:1437827813
Name:KNIGHT, JORDAN PARISH (PTA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:PARISH
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14711 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1127
Mailing Address - Country:US
Mailing Address - Phone:718-377-5000
Mailing Address - Fax:718-377-5002
Practice Address - Street 1:14711 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436-1127
Practice Address - Country:US
Practice Address - Phone:718-377-5000
Practice Address - Fax:718-377-5002
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010909225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant