Provider Demographics
NPI:1770909475
Name:KING VENTURES
Entity type:Organization
Organization Name:KING VENTURES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:ANTWAN
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:931-552-2804
Mailing Address - Street 1:2766 WILMA RUDOLPH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5837
Mailing Address - Country:US
Mailing Address - Phone:931-552-2804
Mailing Address - Fax:931-552-2809
Practice Address - Street 1:2766 WILMA RUDOLPH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5837
Practice Address - Country:US
Practice Address - Phone:931-552-2804
Practice Address - Fax:931-552-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty