Provider Demographics
NPI:1023456316
Name:KING INTERVENTIONAL THERAPY, LLC
Entity type:Organization
Organization Name:KING INTERVENTIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GIPSON-KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-831-6972
Mailing Address - Street 1:5018 MONT ST
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-8011
Mailing Address - Country:US
Mailing Address - Phone:606-831-6972
Mailing Address - Fax:
Practice Address - Street 1:5018 MONT ST
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129-8011
Practice Address - Country:US
Practice Address - Phone:606-831-6972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002254251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health