Provider Demographics
NPI:1629791561
Name:KNOTTS, ROBBIE P
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:P
Last Name:KNOTTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:MOUNT NEBO
Mailing Address - State:WV
Mailing Address - Zip Code:26679-0596
Mailing Address - Country:US
Mailing Address - Phone:304-883-2334
Mailing Address - Fax:
Practice Address - Street 1:785 SUMMERSVILLE LAKE RD
Practice Address - Street 2:
Practice Address - City:MOUNT NEBO
Practice Address - State:WV
Practice Address - Zip Code:26679-9203
Practice Address - Country:US
Practice Address - Phone:304-883-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant