Provider Demographics
NPI:1871764209
Name:KING PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:KING PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:304-262-8161
Mailing Address - Street 1:55 MERIDIAN PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-5422
Mailing Address - Country:US
Mailing Address - Phone:304-262-8161
Mailing Address - Fax:
Practice Address - Street 1:55 MERIDIAN PKWY STE 110
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-5422
Practice Address - Country:US
Practice Address - Phone:304-262-8161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001709268OtherBCBS
WV7923672OtherAETNA
11547365OtherCAQH ID NUMBER
WVY28463Medicare UPIN