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NPI Code Detail

MEDICARE: MR. RYAN DAVID KING D.P.T.

MEDICARE: MR. RYAN DAVID KING D.P.T.
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
1225100000XPhysical Therapist292587CA

General Provider Information

NPI Number : 1356886600
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RYAN DAVID KING D.P.T.
Provider Business Mailing Address
First Line : 1600 DOVE ST STE 100
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-2438
Country : US
Telephone Number : 949-502-3388
Fax Number :
Provider Business Practice Location Address
First Line : 1600 DOVE ST STE 100
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-2438
Country : US
Telephone Number : 949-502-3388
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2016
Last Update Date : 12/22/2016

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