Provider Demographics
NPI:1851326540
Name:KNOWLES, KELLY S (RPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL ST
Mailing Address - Street 2:
Mailing Address - City:SNEAD
Mailing Address - State:AL
Mailing Address - Zip Code:35952-6593
Mailing Address - Country:US
Mailing Address - Phone:205-359-2850
Mailing Address - Fax:205-453-6169
Practice Address - Street 1:200 MEDICAL ST
Practice Address - Street 2:
Practice Address - City:SNEAD
Practice Address - State:AL
Practice Address - Zip Code:35952
Practice Address - Country:US
Practice Address - Phone:205-359-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51531136OtherBCBS OF ALABAMA
ALQ57724Medicare UPIN
AL51531136OtherBCBS OF ALABAMA