Provider Demographics
NPI:1700698669
Name:KNOBLOCH, PATRICIA ANN (LMT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:KNOBLOCH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:GOSSELIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1523 KOENE PL
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1908
Mailing Address - Country:US
Mailing Address - Phone:808-446-1639
Mailing Address - Fax:
Practice Address - Street 1:16 S MARKET ST STE 2B
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2201
Practice Address - Country:US
Practice Address - Phone:808-446-1639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-13568225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist