Provider Demographics
NPI:1063675304
Name:KING, MICHAEL ADAM (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ADAM
Last Name:KING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:21391 N LAKE PLEASANT PKWY
Mailing Address - Street 2:STE 1810
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2000
Mailing Address - Country:US
Mailing Address - Phone:623-398-8072
Mailing Address - Fax:623-398-8235
Practice Address - Street 1:21391 N LAKE PLEASANT PKWY
Practice Address - Street 2:STE 1810
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2000
Practice Address - Country:US
Practice Address - Phone:602-795-8441
Practice Address - Fax:602-795-8447
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2018-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT70303922401225100000X
AZ11446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist