Provider Demographics
NPI:1801925730
Name:KNELLER, SCOTT DANIEL (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DANIEL
Last Name:KNELLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 ROTHBURY DR
Mailing Address - Street 2:
Mailing Address - City:WHISPERING PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28327-9533
Mailing Address - Country:US
Mailing Address - Phone:810-625-1872
Mailing Address - Fax:
Practice Address - Street 1:302 SELKIRK TRL
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7233
Practice Address - Country:US
Practice Address - Phone:810-625-1872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2017-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015127225100000X
AZ7604225100000X
NCP12948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist