MEDICARE: MISS ANNE MICHELLE KING PTA

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	225200000X	Physical Therapy Assistant	2143	NC
2	225200000X	Physical Therapy Assistant	056773	OH
3	225200000X	Physical Therapy Assistant	2033645	TX

General Provider Information

NPI Number	:	1194942946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANNE MICHELLE KING PTA

Provider Business Mailing Address
First Line	:	6225 CRESTLINE RD
Second Line	:
City	:	GALION
State	:	OH
Zip	:	44833-8942
Country	:	US
Telephone Number	:	979-220-9624
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 N SAINT PAUL ST
Second Line	:	SUITE 4200
City	:	DALLAS
State	:	TX
Zip	:	75201-3801
Country	:	US
Telephone Number	:	866-953-0011
Fax Number	:

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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