MEDICARE: RONALD ALVY 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	PT007489L	PA

General Provider Information

NPI Number	:	1841253283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD ALVY KING PT

Provider Business Mailing Address
First Line	:	265 ELM DR
Second Line	:
City	:	WAYNESBURG
State	:	PA
Zip	:	15370-8275
Country	:	US
Telephone Number	:	724-627-0685
Fax Number	:	724-627-0849

Provider Business Practice Location Address
First Line	:	265 ELM DR
Second Line	:
City	:	WAYNESBURG
State	:	PA
Zip	:	15370-8275
Country	:	US
Telephone Number	:	724-627-0685
Fax Number	:	724-627-0849

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	07/08/2007

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