Provider Demographics
NPI:1083042006
Name:KING, STEPHANIE (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:MO
Mailing Address - Zip Code:65275-1165
Mailing Address - Country:US
Mailing Address - Phone:660-327-1024
Mailing Address - Fax:660-327-1024
Practice Address - Street 1:200 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:MO
Practice Address - Zip Code:65275-0001
Practice Address - Country:US
Practice Address - Phone:660-327-4125
Practice Address - Fax:660-327-1024
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013028652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist