Provider Demographics
NPI:1649432568
Name:MCKNIGHT, WILLIAM RONALD (LMT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RONALD
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:74 SUNSET HILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2923
Mailing Address - Country:US
Mailing Address - Phone:203-778-8292
Mailing Address - Fax:203-743-0572
Practice Address - Street 1:74 SUNSET HILL RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2923
Practice Address - Country:US
Practice Address - Phone:203-778-8292
Practice Address - Fax:203-743-0572
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000514225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist