Provider Demographics
NPI:1639390149
Name:MCKNIGHT, REBECCA SUSANNIE (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUSANNIE
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 FIELD RD
Mailing Address - Street 2:
Mailing Address - City:POWERSITE
Mailing Address - State:MO
Mailing Address - Zip Code:65731
Mailing Address - Country:US
Mailing Address - Phone:417-339-2095
Mailing Address - Fax:
Practice Address - Street 1:303 FIELD RD
Practice Address - Street 2:
Practice Address - City:POWERSITE
Practice Address - State:MO
Practice Address - Zip Code:65731
Practice Address - Country:US
Practice Address - Phone:417-339-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist