Provider Demographics
NPI:1629478862
Name:KING, JOSHUA (LMT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 S FASHION BLVD STE 175
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8115
Mailing Address - Country:US
Mailing Address - Phone:801-910-6683
Mailing Address - Fax:
Practice Address - Street 1:5801 S FASHION BLVD STE 175
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8115
Practice Address - Country:US
Practice Address - Phone:801-910-6683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8298267-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist