Provider Demographics
NPI:1932238193
Name:KNUDTSON, JAMES ARTHUR (ATC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ARTHUR
Last Name:KNUDTSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 CRICKET LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-2403
Mailing Address - Country:US
Mailing Address - Phone:423-847-9664
Mailing Address - Fax:
Practice Address - Street 1:405 PIERCE RD
Practice Address - Street 2:
Practice Address - City:EVENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37332-3223
Practice Address - Country:US
Practice Address - Phone:423-775-7821
Practice Address - Fax:423-775-7823
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer