Healthcare Provider Details

I. General information

NPI: 1467376657
Provider Name (Legal Business Name): CARSON KING PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 DUNLAWTON AVE
PORT ORANGE FL
32127-4225
US

IV. Provider business mailing address

742 SANDY HILL CIR
PORT ORANGE FL
32127-7794
US

V. Phone/Fax

Practice location:
  • Phone: 386-756-0077
  • Fax:
Mailing address:
  • Phone: 386-295-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: