MEDICARE: MRS. ANITA 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
1	225100000X	Physical Therapist	5501010934	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1790743201	OTHER	MI	NPI

General Provider Information

NPI Number	:	1790743201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANITA KING PT

Provider Business Mailing Address
First Line	:	5590 MAIN ST
Second Line	:	SUITE 4
City	:	LEXINGTON
State	:	MI
Zip	:	48450-9383
Country	:	US
Telephone Number	:	810-359-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	5590 MAIN ST
Second Line	:	SUITE 4
City	:	LEXINGTON
State	:	MI
Zip	:	48450-9383
Country	:	US
Telephone Number	:	810-359-8700
Fax Number	:

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	02/02/2009

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Directions to “ MRS. ANITA KING PT” Practice Location

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