Provider Demographics
NPI:1841414034
Name:KING, LEONARD RAYMOND (ATC)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:RAYMOND
Last Name:KING
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 WISTERIA CIR
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-6982
Mailing Address - Country:US
Mailing Address - Phone:843-861-0977
Mailing Address - Fax:
Practice Address - Street 1:1740 WISTERIA CIR
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-6982
Practice Address - Country:US
Practice Address - Phone:843-861-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer