Provider Demographics
NPI:1841642626
Name:KING, TABITHA (LMT)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3794 TOWNE POINT RD APT G
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2562
Mailing Address - Country:US
Mailing Address - Phone:757-635-7280
Mailing Address - Fax:
Practice Address - Street 1:100 ANNA GOODE WAY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-9236
Practice Address - Country:US
Practice Address - Phone:757-635-7280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019007821174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist