Provider Demographics
NPI:1659741353
Name:KNOOP, BRETT MARTIN (MED, AT, ATC)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:MARTIN
Last Name:KNOOP
Suffix:
Gender:M
Credentials:MED, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 KRAFT AVE SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-7304
Mailing Address - Country:US
Mailing Address - Phone:616-891-8129
Mailing Address - Fax:616-891-7035
Practice Address - Street 1:9050 KRAFT AVE SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7304
Practice Address - Country:US
Practice Address - Phone:616-891-8129
Practice Address - Fax:616-891-7035
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010003852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer