Provider Demographics
NPI:1649293960
Name:KING, STACY EICHWALD (MSPT, CIMT)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:EICHWALD
Last Name:KING
Suffix:
Gender:F
Credentials:MSPT, CIMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 WINDING ROSE DR.
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-340-7653
Mailing Address - Fax:301-340-7653
Practice Address - Street 1:6410 ROCKLEDGE DR.
Practice Address - Street 2:#301
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-897-0357
Practice Address - Fax:301-897-2148
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD195732251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01783Medicare ID - Type Unspecified