Provider Demographics
NPI:1255670964
Name:KING, PATRICK E (DPT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:E
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 1:723 BAXTER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1109
Mailing Address - Country:US
Mailing Address - Phone:706-355-3025
Mailing Address - Fax:706-355-3039
Practice Address - Street 1:723 BAXTER ST
Practice Address - Street 2:SUITE B
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1109
Practice Address - Country:US
Practice Address - Phone:706-355-3035
Practice Address - Fax:706-355-3039
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist