Provider Demographics
NPI:1508287848
Name:KNOLL, DEANNA CAROL (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:CAROL
Last Name:KNOLL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 PROVIDENCE LANE NE
Mailing Address - Street 2:PROVIDENCE ST PETER HOSPITAL
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-493-4995
Mailing Address - Fax:360-493-7977
Practice Address - Street 1:410 PROVIDENCE LN NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-6927
Practice Address - Country:US
Practice Address - Phone:360-493-4995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 000077772251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA910567732Medicaid