Provider Demographics
NPI:1851459861
Name:KING, KIA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:KIA
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12812 101ST AVENUE CT E
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-9101
Mailing Address - Country:US
Mailing Address - Phone:253-841-4457
Mailing Address - Fax:253-841-8526
Practice Address - Street 1:12812 101ST AVENUE CT E
Practice Address - Street 2:SUITE 104
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-9101
Practice Address - Country:US
Practice Address - Phone:253-841-4457
Practice Address - Fax:253-841-8526
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020868225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist