Provider Demographics
NPI:1346380193
Name:KING, ANGELA RENAE (PT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:RENAE
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 1:2003 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-9700
Mailing Address - Country:US
Mailing Address - Phone:706-282-4461
Mailing Address - Fax:706-282-4416
Practice Address - Street 1:2003 FALLS RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-9700
Practice Address - Country:US
Practice Address - Phone:706-282-4461
Practice Address - Fax:706-282-4416
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist