Provider Demographics
NPI:1497924104
Name:KING, MATTHEW J (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:KING
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 LOUISIANA DRIVE
Mailing Address - Street 2:
Mailing Address - City:DYES AFB
Mailing Address - State:TX
Mailing Address - Zip Code:79607-1367
Mailing Address - Country:US
Mailing Address - Phone:325-696-5451
Mailing Address - Fax:
Practice Address - Street 1:525 AVENUE B
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79607-1409
Practice Address - Country:US
Practice Address - Phone:325-696-5451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11798492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00457UMedicare UPIN