Provider Demographics
NPI:1710316914
Name:MCKNIGHT, CARMEN (MA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29642 57TH PL S
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-2387
Mailing Address - Country:US
Mailing Address - Phone:206-458-2233
Mailing Address - Fax:
Practice Address - Street 1:33650 6TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6754
Practice Address - Country:US
Practice Address - Phone:253-942-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60418604225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA 60418604OtherWASHINGTON STATE DEPARTMENT OF HEALTH