Provider Demographics
NPI:1356058879
Name:KING, ABAGAYLE LOUISE (DPT)
Entity type:Individual
Prefix:
First Name:ABAGAYLE
Middle Name:LOUISE
Last Name:KING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MCCALEB RD APT 7104
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-5226
Mailing Address - Country:US
Mailing Address - Phone:708-272-2631
Mailing Address - Fax:
Practice Address - Street 1:2956 I-45 NORTH
Practice Address - Street 2:SUITE 500
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77303
Practice Address - Country:US
Practice Address - Phone:936-441-4422
Practice Address - Fax:936-441-4427
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1368573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist