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General NPI Number Information
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NPI Number | 1528653557
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Entity Type | Individual
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Provider Name | KENNETH JOSEPH KING LAT
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Gender | Male
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Dates
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Enumeration Date | 03/02/2021
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 23203 BULVERDE RD
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City | SAN ANTONIO
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State | TX
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Zip | 78259-2203
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Country | US
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Telephone | 210-356-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 8976 SCARLET CRK
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City | UNIVERSAL CITY
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State | TX
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Zip | 78148-3785
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Country | US
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Telephone | 210-445-7489
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 3935
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License Number State | TX
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