Provider Demographics
NPI:1669500179
Name:KING, KAREN ROSE (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ROSE
Last Name:KING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 RIDGE RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6670
Mailing Address - Country:US
Mailing Address - Phone:972-771-4343
Mailing Address - Fax:
Practice Address - Street 1:2931 RIDGE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6670
Practice Address - Country:US
Practice Address - Phone:972-771-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist