Provider Demographics
NPI:1770021065
Name:MCKNIGHT, SAMANTHA (PTA0013943)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:PTA0013943
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1486 28TH LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81006-9648
Mailing Address - Country:US
Mailing Address - Phone:719-369-2237
Mailing Address - Fax:
Practice Address - Street 1:1486 28TH LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81006-9648
Practice Address - Country:US
Practice Address - Phone:719-369-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013943225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant