Provider Demographics
NPI:1134426299
Name:KING, LEO J (PT)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:J
Last Name:KING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:805 AEROVISTA PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7919
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:82013 DR CARREON BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4832
Practice Address - Country:US
Practice Address - Phone:760-347-6195
Practice Address - Fax:760-347-2849
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA37602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist