MEDICARE: LANCE BRYAN KING

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1952697021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE BRYAN KING

Provider Business Mailing Address
First Line	:	3351 INDIAN SHADOW ST APT 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3351 INDIAN SHADOW ST APT 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8631
Country	:	US
Telephone Number	:	702-539-7225
Fax Number	:

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

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	06/27/2011

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Directions to “ LANCE BRYAN KING ” Practice Location

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