Provider Demographics
NPI:1144577677
Name:KING, KEVIN ADRIAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ADRIAN
Last Name:KING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 VILLAGE PARK LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-5174
Mailing Address - Country:US
Mailing Address - Phone:706-454-1811
Mailing Address - Fax:706-454-1812
Practice Address - Street 1:1010 VILLAGE PARK LN
Practice Address - Street 2:SUITE 102
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-5174
Practice Address - Country:US
Practice Address - Phone:706-454-1811
Practice Address - Fax:706-454-1812
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist