Provider Demographics
NPI:1750377040
Name:KNUDSON, HOWARD J (MSPT)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:J
Last Name:KNUDSON
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CETRONIA ROAD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9569
Mailing Address - Country:US
Mailing Address - Phone:484-426-2544
Mailing Address - Fax:484-426-2444
Practice Address - Street 1:501 CETRONIA RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9569
Practice Address - Country:US
Practice Address - Phone:484-426-2544
Practice Address - Fax:484-426-2444
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015868225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7552649OtherAETNA
PA1418441OtherFIRST PRIORITY LIFE
PA50041071OtherBLUE CROSS
PA1418441OtherBLUE SHIELD
PA1418441OtherPERSONAL CHOICE
PA0052130OtherORTHONET
PA1418441OtherPERSONAL CHOICE