KNICLEY SE, LLC (NPI# 1619480258) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619480258 |
| Entity Type | Organization |
| Organization Name | KNICLEY SE, LLC |
| Other Organization Name | STRUCTURAL ELEMENTS |
| Practice Address |
3540 Sugarloaf Pkwy Ste D03 Frederick MD 21704-7901 |
| Mailing Address |
9210 Landon House Way Frederick MD 21704-7766 |
| Practice Telephone | 3019926797 |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2019-06-11 |
| Authorized Official Name | JASON KNICLEY (PT, OWNER, OPERATOR) |
| Authorized Official Telephone | 3019926797 |
| Authorized Official Credential | PT, DPT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251X0800X |
Physical Therapist Specialization: Orthopedic |
23476 | MD | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Other Name | Type Code |
|---|---|
| Structural Elements | Doing Business As Name - Organization |
| Street Address |
3540 SUGARLOAF PKWY STE D03 |
| City | FREDERICK |
| State | MD |
| Zip Code | 21704-7901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144747148 | Danah Jack | Physical Therapist | 4070 Atterbury Place, Frederick, MD 21704 | 2017-08-29 |
| 1568986891 | Amy Benjamin Slp | Speech-Language Pathologist | 8905 Amelung St, Frederick, MD 21704 | 2017-07-28 |
| 1104352368 | Mentor-maryland | Community/Behavioral Health | 5970 Frederick Crossing Lane, #202, Frederick, MD 21704 | 2017-05-10 |
| 1699193284 | Jiang Tan | Acupuncturist | 3520 Worthington Blvd #101, Frederick, MD 21704 | 2014-04-01 |
| 1326460817 | Jessica Lacayo | Nurse Practitioner | 3350 Worthington Boulevard, Urbana, MD 21704 | 2014-01-17 |
| 1588098818 | Kimberly Kaye Dipietro | Registered Nurse | 9006 Harris Street, Frederick, MD 21704 | 2013-08-22 |
| 1831432525 | Yuqing Meng | Pharmacist | 9317 Elgin Lane, Frederick, MD 21704 | 2013-04-01 |
| 1831446285 | Diane Marie Foland | Behavioral Analyst | 4235 Lafayette Street, Frederick, MD 21704 | 2012-08-03 |
| 1982932695 | Contemporary Therapeutic Services Inc | Community/Behavioral Health | 22 N Potomac Street, Ste 102, Hagerstown, MD 21704 | 2009-11-19 |
| 1942461181 | Hoa T K Lam | Dentist | 7360 Guilford Drive, Suite #102, Frederick, MD 21704 | 2008-06-20 |
| Find all providers in zip 21704 | ||||
| Taxonomy Code | 2251X0800X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Orthopedic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356635155 | Lauren Jordae Baker | Physical Therapist | 84 Thomas Johnson Ct # B, Frederick, MD 21702-4348 | 2011-06-09 |
| 1932205424 | Wray Pardy Pianta | Physical Therapist | 6605 Fox Meade Ct, Frederick, MD 21702-9493 | 2006-09-15 |
| 1073511440 | Yvonne Townsley Anderson | Physical Therapist | 3430 Worthington Blvd, Suite 102, Frederick, MD 21704-7017 | 2005-07-11 |
| 1053970335 | Lucas Lin Chang | Physical Therapist | 86 Thomas Johnson Ct, Frederick, MD 21702-4348 | 2019-06-10 |
| 1144416470 | Brenda Jane Cline Rich | Physical Therapist | 198 Thomas Johnson Dr, Suite 201, Frederick, MD 21702-4398 | 2007-09-20 |
| 1528191368 | M Jean Giove | Physical Therapist | 75 Thomas Johnson Dr, Suite M, Frederick, MD 21702-4895 | 2007-03-13 |
| 1255479747 | Season Paige Rumpff | Physical Therapist | 86 Thomas Johnson Ct, Frederick, MD 21702-4348 | 2007-02-05 |
| 1841204823 | Fredericks Sport and Spine Clinic Inc | Physical Therapist | 84 Thomas Johnson Ct, Suite B, Frederick, MD 21702-4348 | 2006-07-28 |
| 1881610483 | Jodene Ann Acierno | Physical Therapist | 84 Thomas Johnson Ct, Suite B, Frederick, MD 21702-4348 | 2006-07-15 |
| 1669479382 | Christopher Peter Butler | Physical Therapist | 75 Thomas Johnson Drive, Suite L, Frederick, MD 21702-4895 | 2005-07-07 |
| Find all providers in FREDERICK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.