Provider Demographics
NPI:1205055498
Name:KING, CRISTINA
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 N DIXIE HWY
Mailing Address - Street 2:#18
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-6274
Mailing Address - Country:US
Mailing Address - Phone:561-876-2119
Mailing Address - Fax:561-822-3414
Practice Address - Street 1:2502 N DIXIE HWY
Practice Address - Street 2:#18
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-6274
Practice Address - Country:US
Practice Address - Phone:561-876-2119
Practice Address - Fax:561-822-3414
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811817500Medicaid