Provider Demographics
NPI:1316374515
Name:KING, TERRY (PT)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 OLD MOUNTAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085
Mailing Address - Country:US
Mailing Address - Phone:410-868-7387
Mailing Address - Fax:
Practice Address - Street 1:1212 OLD MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085
Practice Address - Country:US
Practice Address - Phone:410-868-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15553174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist