Provider Demographics
NPI:1871924811
Name:KING, MARLENE
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:A
Other - Last Name:HAVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1500 JACKSON ST
Mailing Address - Street 2:400
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3668
Mailing Address - Country:US
Mailing Address - Phone:281-344-8900
Mailing Address - Fax:281-344-8926
Practice Address - Street 1:1500 JACKSON ST
Practice Address - Street 2:400
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3668
Practice Address - Country:US
Practice Address - Phone:281-344-8900
Practice Address - Fax:281-344-8926
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161000174400000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherPENDING