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NPI Code Detail

MEDICARE: MR. NEIL GREGORY KING PT

MEDICARE: MR. NEIL GREGORY KING PT
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 Therapist5501007556MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P55360001OTHERMIMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1650F357680OTHERMIBLUE CROSS

General Provider Information

NPI Number : 1467410886
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NEIL GREGORY KING PT
Provider Business Mailing Address
First Line : 141 HAMPTON CIR
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-4103
Country : US
Telephone Number : 248-583-7555
Fax Number : 248-853-7556
Provider Business Practice Location Address
First Line : 141 HAMPTON CIR
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-4103
Country : US
Telephone Number : 248-583-7555
Fax Number : 248-853-7556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 09/06/2013

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