Provider Demographics
NPI:1508394248
Name:KNOBLE, BONI MAE (DPT)
Entity Type:Individual
Prefix:
First Name:BONI
Middle Name:MAE
Last Name:KNOBLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BONI
Other - Middle Name:MAE
Other - Last Name:SLAGERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2737 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2246
Mailing Address - Country:US
Mailing Address - Phone:608-299-8181
Mailing Address - Fax:608-299-8281
Practice Address - Street 1:2737 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2246
Practice Address - Country:US
Practice Address - Phone:608-299-8181
Practice Address - Fax:608-299-8281
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics