Provider Demographics
NPI:1245485150
Name:KNIGHT, SUMMER DAWN (LMT)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:DAWN
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 SW 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2537
Mailing Address - Country:US
Mailing Address - Phone:503-449-4099
Mailing Address - Fax:
Practice Address - Street 1:7645 SW CAPITOL HWY
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2436
Practice Address - Country:US
Practice Address - Phone:503-449-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10595174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist