Provider Demographics
NPI:1194942946
Name:KING, ANNE MICHELLE (PTA)
Entity type:Individual
Prefix:MISS
First Name:ANNE
Middle Name:MICHELLE
Last Name:KING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 CRESTLINE RD
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-8942
Mailing Address - Country:US
Mailing Address - Phone:979-220-9624
Mailing Address - Fax:
Practice Address - Street 1:325 N SAINT PAUL ST
Practice Address - Street 2:SUITE 4200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3801
Practice Address - Country:US
Practice Address - Phone:866-953-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2143225200000X
OH056773225200000X
TX2033645225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant