MEDICARE: JEANNETHE KING

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	225100000X	Physical Therapist	039287	NY

General Provider Information

NPI Number	:	1043686801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNETHE KING

Provider Business Mailing Address
First Line	:	2142 UTOPIA PKWY
Second Line	:
City	:	WHITESTONE
State	:	NY
Zip	:	11357-4142
Country	:	US
Telephone Number	:	718-819-6800
Fax Number	:	347-841-9109

Provider Business Practice Location Address
First Line	:	54 MURRAY ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-2219
Country	:	US
Telephone Number	:	212-453-4622
Fax Number	:	212-453-4621

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

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	08/17/2015

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Directions to “ JEANNETHE KING ” Practice Location

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