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General NPI Number Information
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NPI Number | 1669130613
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Entity Type | Individual
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Provider Name | SOVONYA KING LMT
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Gender | Female
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 11011 S 48TH ST STE 106
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City | PHOENIX
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State | AZ
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Zip | 85044-1787
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Country | US
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Telephone | 602-999-3595
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Fax |
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Provider Business Mailing Address
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Address Line | 3802 E BASELINE RD APT 1048
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City | PHOENIX
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State | AZ
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Zip | 85042-7239
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Country | US
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Telephone | 602-999-3595
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT-28054
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License Number State | AZ
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