Basic Information
Provider Information
NPI: 1396321659
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KNIGHT
FirstName: SARAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 576 BROADHOLLOW RD
Address2: SUITE PROEX
City: MELVILLE
State: NY
PostalCode: 117475002
CountryCode: US
TelephoneNumber: 6313595859
FaxNumber:  
Practice Location
Address1: 55R WASHINGTON ST
Address2:  
City: NORWELL
State: MA
PostalCode: 020611782
CountryCode: US
TelephoneNumber: 7818719500
FaxNumber: 7818719525
Other Information
ProviderEnumerationDate: 03/18/2021
LastUpdateDate: 03/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X25404MAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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