Provider Demographics
NPI:1669893780
Name:KNOTTS, THOMAS (AT,C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:KNOTTS
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 RITCHIE COUNTY SCHOOL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ELLENBORO
Mailing Address - State:WV
Mailing Address - Zip Code:26346-6704
Mailing Address - Country:US
Mailing Address - Phone:304-869-3526
Mailing Address - Fax:
Practice Address - Street 1:201 RITCHIE COUNTY SCHOOL RD STE 1
Practice Address - Street 2:
Practice Address - City:ELLENBORO
Practice Address - State:WV
Practice Address - Zip Code:26346-6704
Practice Address - Country:US
Practice Address - Phone:304-869-3526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0012642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer