MEDICARE: GARRETT KING DPT

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	11214	SC

General Provider Information

NPI Number	:	1427708536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRETT KING DPT

Provider Business Mailing Address
First Line	:	1504 CAROLNA PLACE DR STE 114
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-7058
Country	:	US
Telephone Number	:	803-349-3449
Fax Number	:	803-753-8476

Provider Business Practice Location Address
First Line	:	1504 CAROLNA PLACE DR STE 114
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-7058
Country	:	US
Telephone Number	:	803-349-3449
Fax Number	:	803-753-8476

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

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/24/2022

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