Provider Demographics
NPI:1386765022
Name:KING, STACEY SHEREE (PT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:SHEREE
Last Name:KING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CLINCHFIELD ST STE 320
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3856
Mailing Address - Country:US
Mailing Address - Phone:423-251-4742
Mailing Address - Fax:423-251-4743
Practice Address - Street 1:300 CLINCHFIELD ST STE 320
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3856
Practice Address - Country:US
Practice Address - Phone:423-251-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist