Provider Demographics
NPI:1396708152
Name:KING, LISHA DAWNE (MS, ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:LISHA
Middle Name:DAWNE
Last Name:KING
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801A S BARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-6919
Mailing Address - Country:US
Mailing Address - Phone:660-829-0733
Mailing Address - Fax:660-829-0733
Practice Address - Street 1:1330 COMMERCIAL ST
Practice Address - Street 2:STE 100
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355
Practice Address - Country:US
Practice Address - Phone:660-438-5063
Practice Address - Fax:660-438-7409
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19991350432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer