Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT14818 | FL |
NPI | 1003049834 |
---|---|
Provider Name | Richard Thomas King V |
First Address | Melbourne, FL 32935-6858 |
Second Address | Melbourne, FL 32935-6858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2009 |
Last Update Date | 27/08/2009 |