Provider Demographics
NPI:1497394001
Name:KING, KALA M
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:M
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KALA
Other - Middle Name:
Other - Last Name:ROBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:12200 DALTON LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7026
Mailing Address - Country:US
Mailing Address - Phone:757-897-0535
Mailing Address - Fax:
Practice Address - Street 1:4831 S LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-2713
Practice Address - Country:US
Practice Address - Phone:804-222-0745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist