MEDICARE: MRS. WILMA ASKEW KING MSPT

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	0002748	SC

General Provider Information

NPI Number	:	1629031802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WILMA ASKEW KING MSPT

Provider Business Mailing Address
First Line	:	205 LONG CRESCENT DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-1453
Country	:	US
Telephone Number	:	919-286-0411
Fax Number	:	919-416-5913

Provider Business Practice Location Address
First Line	:	205 LONG CRESCENT DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-1453
Country	:	US
Telephone Number	:	919-286-0411
Fax Number	:	919-416-5913

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2007

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