Provider Demographics
NPI:1194591834
Name:KING, RENEE KATHLEEN (MPT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:KATHLEEN
Last Name:KING
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 272ND PL NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-7449
Mailing Address - Country:US
Mailing Address - Phone:360-386-3106
Mailing Address - Fax:360-999-5645
Practice Address - Street 1:9901 272ND PL NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-7449
Practice Address - Country:US
Practice Address - Phone:360-386-3106
Practice Address - Fax:360-999-5645
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist