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NPI Code Detail

MEDICARE: JESSICA L KING RPT

MEDICARE: JESSICA L KING RPT
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
1225100000XPhysical Therapist11-03449KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1115652OTHERKSBCBS #

General Provider Information

NPI Number : 1376622886
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA L KING RPT
Provider Business Mailing Address
First Line : 101 E FULTON ST
Second Line :
City : GARDEN CITY
State : KS
Zip : 67846-5455
Country : US
Telephone Number : 620-275-8400
Fax Number : 620-275-2687
Provider Business Practice Location Address
First Line : 101 E FULTON ST
Second Line :
City : GARDEN CITY
State : KS
Zip : 67846-5455
Country : US
Telephone Number : 620-275-8400
Fax Number : 620-275-2687
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2006
Last Update Date : 07/08/2007

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