Provider Demographics
NPI:1720849326
Name:KNUCKEY, HEATHER L (LMT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:KNUCKEY
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 1:8227 FORT SMALLWOOD RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:21226
Mailing Address - Country:US
Mailing Address - Phone:443-865-5557
Mailing Address - Fax:
Practice Address - Street 1:8227 FORT SMALLWOOD RD UNIT A
Practice Address - Street 2:
Practice Address - City:CLEARWATER BEACH
Practice Address - State:MD
Practice Address - Zip Code:21226
Practice Address - Country:US
Practice Address - Phone:443-865-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04640225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist