Provider Demographics
NPI:1790743201
Name:KING, ANITA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
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 1:5590 MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LEXINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48450-9383
Mailing Address - Country:US
Mailing Address - Phone:810-359-8700
Mailing Address - Fax:
Practice Address - Street 1:5590 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LEXINGTON
Practice Address - State:MI
Practice Address - Zip Code:48450-9383
Practice Address - Country:US
Practice Address - Phone:810-359-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790743201OtherNPI