Provider Demographics
NPI:1326385709
Name:KING, DEBORAH J (MT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:KING
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13256 NATCHEZ AVE
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-1633
Mailing Address - Country:US
Mailing Address - Phone:952-451-1086
Mailing Address - Fax:800-913-1883
Practice Address - Street 1:13256 NATCHEZ AVE
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-1633
Practice Address - Country:US
Practice Address - Phone:952-451-1086
Practice Address - Fax:800-913-1883
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist