Provider Demographics
NPI:1902133226
Name:KING, DENISE INGALLS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:INGALLS
Last Name:KING
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13241 BRIDGEFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-3451
Mailing Address - Country:US
Mailing Address - Phone:201-988-0876
Mailing Address - Fax:
Practice Address - Street 1:13241 BRIDGEFORD AVE
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-3451
Practice Address - Country:US
Practice Address - Phone:201-988-0876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00466600225100000X
FLPT22614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist