MEDICARE: TERRY KING PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	15553	MD

General Provider Information

NPI Number	:	1316374515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY KING PT

Provider Business Mailing Address
First Line	:	1212 OLD MOUNTAIN ROAD
Second Line	:
City	:	JOPPA
State	:	MD
Zip	:	21085
Country	:	US
Telephone Number	:	410-868-7387
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 OLD MOUNTAIN ROAD
Second Line	:
City	:	JOPPA
State	:	MD
Zip	:	21085
Country	:	US
Telephone Number	:	410-868-7387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	10/02/2013

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Directions to “ TERRY KING PT” Practice Location

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