Provider Demographics
NPI:1144960733
Name:KNIGHT, BROOKE KATHERINE (PTA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:KATHERINE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 COUNTY ROAD 300 E
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:IL
Mailing Address - Zip Code:62806-4152
Mailing Address - Country:US
Mailing Address - Phone:618-240-5256
Mailing Address - Fax:
Practice Address - Street 1:1527 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863
Practice Address - Country:US
Practice Address - Phone:618-263-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160008977225200000X
IN06006139A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant