Provider Demographics
NPI:1154405686
Name:KING, DOUG J (PT)
Entity type:Individual
Prefix:MR
First Name:DOUG
Middle Name:J
Last Name:KING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2588
Mailing Address - Country:US
Mailing Address - Phone:207-941-8723
Mailing Address - Fax:
Practice Address - Street 1:33 PENN PLZ # B
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3619
Practice Address - Country:US
Practice Address - Phone:207-990-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME289610099Medicaid
MEMM4078Medicare ID - Type Unspecified