Provider Demographics
NPI:1518000652
Name:KNEETER, MARCI CLAIRE (PT)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:CLAIRE
Last Name:KNEETER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARCI
Other - Middle Name:CLAIRE
Other - Last Name:JEFFRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:39180 FARWELL DR STE 211
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1015
Mailing Address - Country:US
Mailing Address - Phone:510-857-1000
Mailing Address - Fax:510-474-1798
Practice Address - Street 1:39180 FARWELL DR STE 211
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:105-857-1000
Practice Address - Fax:510-474-1798
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT206232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT206230Medicare ID - Type UnspecifiedPPIN
CAQ54858Medicare UPIN