Provider Demographics
NPI:1023849700
Name:KING, MAJOR TOM (PT, DPT)
Entity type:Individual
Prefix:
First Name:MAJOR
Middle Name:TOM
Last Name:KING
Suffix:
Gender:M
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 1:1412 CORTELYOU RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5606
Mailing Address - Country:US
Mailing Address - Phone:347-699-1011
Mailing Address - Fax:347-756-7417
Practice Address - Street 1:1412 CORTELYOU RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5606
Practice Address - Country:US
Practice Address - Phone:347-699-1011
Practice Address - Fax:347-756-7417
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist