Provider Demographics
NPI:1477726438
Name:RICHARD M KING
Entity Type:Organization
Organization Name:RICHARD M KING
Other - Org Name:GRAND COULEE PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-633-3260
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:
Mailing Address - City:GRAND COULEE
Mailing Address - State:WA
Mailing Address - Zip Code:99133-0680
Mailing Address - Country:US
Mailing Address - Phone:509-633-3260
Mailing Address - Fax:509-633-3212
Practice Address - Street 1:321 BURDIN BLVD
Practice Address - Street 2:
Practice Address - City:GRAND COULEE
Practice Address - State:WA
Practice Address - Zip Code:99133-0680
Practice Address - Country:US
Practice Address - Phone:509-633-3260
Practice Address - Fax:509-633-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7041320Medicaid
G8802757Medicare PIN