Basic Information
| Provider Information | |||||||||
| NPI: | 1225237001 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNIGHT | ||||||||
| FirstName: | LACY | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9900 MAIN ST | ||||||||
| Address2: | SUITE 200A | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220313907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032794360 | ||||||||
| FaxNumber: | 7032794214 | ||||||||
| Practice Location | |||||||||
| Address1: | 20905 PROFESSIONAL PLZ | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | ASHBURN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201477783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037261616 | ||||||||
| FaxNumber: | 7037261613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305204926 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.