Healthcare Provider Details

I. General information

NPI: 1346380193
Provider Name (Legal Business Name): ANGELA RENAE KING PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 FALLS RD
TOCCOA GA
30577-9700
US

IV. Provider business mailing address

2003 FALLS RD
TOCCOA GA
30577-9700
US

V. Phone/Fax

Practice location:
  • Phone: 706-282-4461
  • Fax: 706-282-4416
Mailing address:
  • Phone: 706-282-4461
  • Fax: 706-282-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT002089
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: