Provider Demographics
NPI:1770785693
Name:KNOELL, BRYAN SCOTT (MS,PT)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:SCOTT
Last Name:KNOELL
Suffix:
Gender:M
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 JEFFERSON COMMONS
Mailing Address - Street 2:
Mailing Address - City:YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11980-2020
Mailing Address - Country:US
Mailing Address - Phone:631-775-0408
Mailing Address - Fax:631-775-0408
Practice Address - Street 1:22 JEFFERSON COMMONS
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980-2020
Practice Address - Country:US
Practice Address - Phone:631-775-0408
Practice Address - Fax:631-775-0408
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026654-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist