Provider Demographics
NPI:1578088902
Name:KNOWLTON, EVAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:KNOWLTON
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 1:173 WASHINGTON ST APT 8
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3148
Mailing Address - Country:US
Mailing Address - Phone:845-588-0380
Mailing Address - Fax:
Practice Address - Street 1:255 WEST ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-2429
Practice Address - Country:US
Practice Address - Phone:603-355-1578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist