Provider Demographics
NPI:1609638832
Name:MCKNIGHT, KRISTINA LEA (RMP)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:LEA
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:RMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-1141
Mailing Address - Country:US
Mailing Address - Phone:443-561-7865
Mailing Address - Fax:
Practice Address - Street 1:4505 NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-1141
Practice Address - Country:US
Practice Address - Phone:443-561-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR03462225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist