Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 60026612 | WA |
NPI | 1003063843 |
---|---|
Provider Name | Courtney M King |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Kirkland, WA 98034-7299 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2008 |
Last Update Date | 30/10/2015 |