Provider Demographics
NPI:1427708536
Name:KING, GARRETT (DPT)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 CAROLNA PLACE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7058
Mailing Address - Country:US
Mailing Address - Phone:803-349-3449
Mailing Address - Fax:803-753-8476
Practice Address - Street 1:1504 CAROLNA PLACE DR STE 114
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7058
Practice Address - Country:US
Practice Address - Phone:803-349-3449
Practice Address - Fax:803-753-8476
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty