MEDICARE: LINDA ANN KING PT, ECS, CHT

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	2251E1300X	Clinical Electrophysiology Physical Therapist	PT000951	GA
2	2251H1200X	Hand Physical Therapist	PT000951	GA
3	2251X0800X	Orthopedic Physical Therapist	PT000951	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GRP3435	OTHER	GA	MEDICARE GROUP NUMBER
2	CL3489	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	101820	OTHER	GA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1790776201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA ANN KING PT, ECS, CHT

Provider Business Mailing Address
First Line	:	2109 N PATTERSON ST
Second Line	:	SUITE A
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2946
Country	:	US
Telephone Number	:	229-247-5225
Fax Number	:	229-241-8471

Provider Business Practice Location Address
First Line	:	2109 N PATTERSON ST
Second Line	:	SUITE A
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2946
Country	:	US
Telephone Number	:	229-247-5225
Fax Number	:	229-241-8471

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	09/27/2007

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Directions to “ LINDA ANN KING PT, ECS, CHT” Practice Location

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