Provider Demographics
NPI:1790776201
Name:KING, LINDA ANN (PT, ECS, CHT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:PT, ECS, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 N PATTERSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2946
Mailing Address - Country:US
Mailing Address - Phone:229-247-5225
Mailing Address - Fax:229-241-8471
Practice Address - Street 1:2109 N PATTERSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2946
Practice Address - Country:US
Practice Address - Phone:229-247-5225
Practice Address - Fax:229-241-8471
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0009512251E1300X, 2251H1200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3435OtherMEDICARE GROUP NUMBER
GACL3489OtherRAILROAD MEDICARE
GA101820OtherBLUE CROSS BLUE SHIELD
GA101820OtherBLUE CROSS BLUE SHIELD
GA65PCBGSMedicare UPIN