Provider Demographics
NPI:1548626542
Name:RYAN J KING PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:RYAN J KING PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, CLT
Authorized Official - Phone:917-648-0265
Mailing Address - Street 1:3054 83RD ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1919
Mailing Address - Country:US
Mailing Address - Phone:917-648-0265
Mailing Address - Fax:
Practice Address - Street 1:3054 83RD ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1919
Practice Address - Country:US
Practice Address - Phone:917-648-0265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027964-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty