Provider Demographics
NPI:1831472745
Name:KING, DEBORHA NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DEBORHA
Middle Name:NICOLE
Last Name:KING
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 OLD MORRILTON HWY
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-3517
Mailing Address - Country:US
Mailing Address - Phone:870-926-3749
Mailing Address - Fax:
Practice Address - Street 1:2125 OLD MORRILTON HWY
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-3517
Practice Address - Country:US
Practice Address - Phone:870-926-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist