Provider Demographics
NPI:1982093134
Name:KING, BRIAN M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
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 1:1118 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-3946
Mailing Address - Country:US
Mailing Address - Phone:415-742-1253
Mailing Address - Fax:415-484-7274
Practice Address - Street 1:1118 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3946
Practice Address - Country:US
Practice Address - Phone:415-742-1253
Practice Address - Fax:415-484-7274
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038580-12251X0800X
CA435382251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic