MEDICARE: VICTORIA DIANE KING PT, DPT

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	225100000X	Physical Therapist	1314888	TX

General Provider Information

NPI Number	:	1801407135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA DIANE KING PT, DPT

Provider Business Mailing Address
First Line	:	12914 EPPS FIELD RD
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-6212
Country	:	US
Telephone Number	:	408-455-5108
Fax Number	:

Provider Business Practice Location Address
First Line	:	7453 LAS COLINAS BLVD
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-7561
Country	:	US
Telephone Number	:	408-455-5108
Fax Number	:

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

Provider Enumeration Date	:	08/11/2020
Last Update Date	:	02/24/2023

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