Provider Demographics
NPI:1790023661
Name:KNOP, ALISA J (PT)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:J
Last Name:KNOP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4553
Mailing Address - Country:US
Mailing Address - Phone:207-899-1922
Mailing Address - Fax:207-899-1923
Practice Address - Street 1:40 MAPLE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4553
Practice Address - Country:US
Practice Address - Phone:207-899-1922
Practice Address - Fax:207-899-1923
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist