Provider Demographics
NPI:1477562130
Name:KING, ROGER ALAN (LPT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:ALAN
Last Name:KING
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-1207
Mailing Address - Country:US
Mailing Address - Phone:903-482-9741
Mailing Address - Fax:903-482-9742
Practice Address - Street 1:176 N. MAIN
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-1207
Practice Address - Country:US
Practice Address - Phone:903-482-9741
Practice Address - Fax:903-482-9742
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1044204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist