Organization
KNICLEY SE, LLC
Active
Other names
Structural Elements
Organization subpart
No
Provider details
NPI number
Authorized official
JASON KNICLEY PT, DPT (PT, OWNER, OPERATOR)
(301) 992-6797
Entity
Organization
Contact information
Practice address
3540 SUGARLOAF PKWY STE D03, FREDERICK, MD 21704-7901
(301) 992-6797
Mailing address
10938 LOUIS DETRICK LN, MONROVIA, MD 21770-6030
(301) 992-6797
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
23476
MD
Other
Enumeration date
11/06/2017
Last updated
07/12/2021
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