| Doctor Name: | MR. JOEL C KNICKERBOCKER |
| NPI Number: | 1639145154 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RPT |
| License Number: | PT0003564 |
| Business Practice Address: | 37104 Clinton Ave Dade City, FL - 335255911 |
| Business Phone Number: | 3525210002 |
| Business Fax Number: | 3525215958 |
| Mailing Address: | Po Box 1001, DADE CITY |
| State: | FL |
| Postal Code: | 335261001 |
| Phone Number: | 3525210002 |
| Fax Number: | 3525215958 |
| NPI Enumeration Date: | 02/24/2006 |
| NPI Last Update Date: | 11/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT0003564 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |