Provider Demographics
NPI:1760896005
Name:KING, MOLLY KAY (DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:KAY
Last Name:KING
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 MADISON AVE N
Mailing Address - Street 2:#3
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-7806
Mailing Address - Country:US
Mailing Address - Phone:612-751-2554
Mailing Address - Fax:
Practice Address - Street 1:440 MADISON AVE N
Practice Address - Street 2:#3
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-7806
Practice Address - Country:US
Practice Address - Phone:612-751-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-15
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085112225100000X
IA0742692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer