Provider Demographics
NPI:1124557673
Name:TEAM KING PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:TEAM KING PHYSICAL THERAPY LLC
Other - Org Name:KING PHYSICAL THERAPY NORTH HUNTINGDON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VISNJA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:724-454-9703
Mailing Address - Street 1:171 W CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3526
Mailing Address - Country:US
Mailing Address - Phone:724-454-9703
Mailing Address - Fax:
Practice Address - Street 1:10709 ROUTE 30
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2047
Practice Address - Country:US
Practice Address - Phone:724-454-9703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021811261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy