Provider Demographics
NPI:1548761703
Name:KNIGHT, ALEXIS D
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:D
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 TAYLOR RANCH RD NW STE C8
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2962
Mailing Address - Country:US
Mailing Address - Phone:505-792-3311
Mailing Address - Fax:
Practice Address - Street 1:6911 TAYLOR RANCH RD NW STE C8
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2962
Practice Address - Country:US
Practice Address - Phone:505-792-3311
Practice Address - Fax:505-792-3312
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7230225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist