Provider Demographics
NPI:1770670036
Name:HOOSE, KNIGHT, AND ASSOCIATES PHYSICAL THERAPY
Entity Type:Organization
Organization Name:HOOSE, KNIGHT, AND ASSOCIATES PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-265-7917
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:14 GARFIELD RD
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-0547
Mailing Address - Country:US
Mailing Address - Phone:315-265-7917
Mailing Address - Fax:315-265-5437
Practice Address - Street 1:14 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3480
Practice Address - Country:US
Practice Address - Phone:315-265-7917
Practice Address - Fax:315-265-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021008-1302R00000X
NY004089-1302R00000X
NY013547-1302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01466182Medicaid
NY01466182Medicaid