Provider Demographics
NPI:1659972594
Name:KNIGHT, TONITA
Entity Type:Individual
Prefix:
First Name:TONITA
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 15TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-2523
Mailing Address - Country:US
Mailing Address - Phone:234-804-3008
Mailing Address - Fax:234-804-3024
Practice Address - Street 1:304 15TH ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-2523
Practice Address - Country:US
Practice Address - Phone:234-804-3008
Practice Address - Fax:234-804-3024
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care