Olivia Gayle King, PTA
Individual provider Active NPI Physical Therapy Assistant · Rolling Fork, MS
NPI 1124536487 · NPPES record last updated Nov 15, 2023
Key facts
- NPI
- 1124536487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 8560 (TN)
- Practice address
- 47 S Fourth St
Rolling Fork, MS 39159-5146 - Phone
- (662) 873-6051
- Fax
- (601) 607-1379
- NPI assigned
- Jan 19, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA6204 | MS | MD | Physical Therapy Assistant |
| 8560 | TN | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 8560 | TN | Yes |
| Physical Therapy Assistant | 225200000X | PTA6204 | MS |
Addresses
Primary practice location
47 S Fourth St
Rolling Fork, MS 39159-5146
Mailing address
711 Avignon Dr
Ridgeland, MS 39157-5120
Phone (601) 605-6777
Other providers in Rolling Fork, MS
- Jackson Rural Health Clinic P a
- Miriam Denise Jackson-Hamilton
- Danny Wade Jackson
- Patsy Johnson
- Kinetix Medical Equipment, LLC
- Mended Hearts Counseling Services, LLC
- Mississippi Christian Family Services Inc
- Mississippi Christian Family Services Inc.
- Mississippi State Department of Health
- North Mississippi Foot Specialists PC
All providers in Rolling Fork, MS · Physical Therapy Assistant in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.