Provider Demographics
NPI:1326023193
Name:KING, DOROTHY MEYER (PT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MEYER
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 1:200 NEWPORT CENTER DR
Mailing Address - Street 2:#213
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7501
Mailing Address - Country:US
Mailing Address - Phone:949-644-1322
Mailing Address - Fax:949-644-0316
Practice Address - Street 1:2888 LONG BEACH BLVD STE 405
Practice Address - Street 2:#405
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1551
Practice Address - Country:US
Practice Address - Phone:562-595-4489
Practice Address - Fax:562-595-4063
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACW086ZMedicare PIN
CAWPT10274AMedicare PIN