Provider Demographics
NPI:1477338663
Name:KNIGHTEN, DAMON OWEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:OWEN
Last Name:KNIGHTEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 SAM TILLMAN RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-7829
Mailing Address - Country:US
Mailing Address - Phone:912-601-9550
Mailing Address - Fax:
Practice Address - Street 1:17707 GA-67
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
Practice Address - Country:US
Practice Address - Phone:912-486-2315
Practice Address - Fax:912-486-2381
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist