Provider Demographics
NPI:1609542943
Name:KNUTSON, TERRI L (PTA)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 FOX VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6120
Mailing Address - Country:US
Mailing Address - Phone:314-550-4458
Mailing Address - Fax:
Practice Address - Street 1:16219 AUTUMN VIEW TERRACE DR
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-4743
Practice Address - Country:US
Practice Address - Phone:636-458-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012025713225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant