Provider Demographics
NPI:1760014922
Name:KING, KAYLEE J
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:J
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WALMART SUPERCENTER
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-6756
Mailing Address - Country:US
Mailing Address - Phone:919-799-2226
Mailing Address - Fax:
Practice Address - Street 1:112 WALMART SUPERCENTER
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-6756
Practice Address - Country:US
Practice Address - Phone:919-799-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist