Provider Demographics
NPI:1679727648
Name:KING, FRANKLIN BRENT (LMT)
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:BRENT
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 1:315 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3114
Mailing Address - Country:US
Mailing Address - Phone:503-522-5959
Mailing Address - Fax:
Practice Address - Street 1:315 2ND ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3114
Practice Address - Country:US
Practice Address - Phone:503-522-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10941171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10941OtherSTATE OF OREGON LICENSED MASSAGE THERAPIST NUMBER