Provider Demographics
NPI:1043532500
Name:KING, RONALD DUANE (PT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DUANE
Last Name:KING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 REDWING CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1910
Mailing Address - Country:US
Mailing Address - Phone:812-376-0719
Mailing Address - Fax:
Practice Address - Street 1:3075 MIDDLE DR
Practice Address - Street 2:STE B
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4483
Practice Address - Country:US
Practice Address - Phone:812-372-7023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002453A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist