Provider Demographics
NPI:1871285676
Name:KNIGHT, BRANDON (LMT)
Entity type:Individual
Prefix:PROF
First Name:BRANDON
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 DAFFODIL CT
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-8132
Mailing Address - Country:US
Mailing Address - Phone:334-313-5316
Mailing Address - Fax:
Practice Address - Street 1:35 WISTERIA PL
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054-1819
Practice Address - Country:US
Practice Address - Phone:334-313-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6182225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist