Provider Demographics
NPI:1053789222
Name:KNIGHT, JOANN PALMER (BCTMB, CMMP, CPMT)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:PALMER
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:BCTMB, CMMP, CPMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LARK CIR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-2258
Mailing Address - Country:US
Mailing Address - Phone:757-591-0125
Mailing Address - Fax:757-591-0125
Practice Address - Street 1:11719-B JEFFERSON AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2166
Practice Address - Country:US
Practice Address - Phone:757-591-0125
Practice Address - Fax:757-591-0125
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019011170225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist