Provider Demographics
NPI:1467410886
Name:KING, NEIL GREGORY (PT)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:GREGORY
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 1:141 HAMPTON CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4103
Mailing Address - Country:US
Mailing Address - Phone:248-583-7555
Mailing Address - Fax:248-853-7556
Practice Address - Street 1:141 HAMPTON CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4103
Practice Address - Country:US
Practice Address - Phone:248-583-7555
Practice Address - Fax:248-853-7556
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650F357680OtherBLUE CROSS
MIP55360001OtherMEDICARE PTAN
MIP55360001OtherMEDICARE PTAN