Provider Demographics
NPI:1275608911
Name:KING, KARLA R (PT)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:R
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 1:772 FOXCROFT AVE # 14
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-1838
Mailing Address - Country:US
Mailing Address - Phone:304-262-8161
Mailing Address - Fax:304-262-6061
Practice Address - Street 1:772 FOXCROFT AVE # 14
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-1838
Practice Address - Country:US
Practice Address - Phone:304-262-8161
Practice Address - Fax:304-262-6061
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV770466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV11547365OtherCAQH ID NUMBER
WV7923672OtherAETNA
WVY28463Medicare UPIN
WV7923672OtherAETNA