Provider Demographics
NPI:1679725949
Name:KNIEST, JOAN MAREE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MAREE
Last Name:KNIEST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5941 SW KARLA CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1185
Mailing Address - Country:US
Mailing Address - Phone:503-246-3193
Mailing Address - Fax:
Practice Address - Street 1:3644 SW TROY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1662
Practice Address - Country:US
Practice Address - Phone:503-246-3193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-18
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11535172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist