Provider Demographics
NPI:1679612865
Name:KNOPF, PHYLLIS HAYYA (PT, MAC)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:HAYYA
Last Name:KNOPF
Suffix:
Gender:F
Credentials:PT, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-3510
Mailing Address - Country:US
Mailing Address - Phone:479-521-1544
Mailing Address - Fax:
Practice Address - Street 1:216 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5959
Practice Address - Country:US
Practice Address - Phone:479-200-5822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000525L171100000X
ARPT 2922225100000X
PAPT002254E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist