Marcus Shannon King, PT ATC LAT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT2745 Issued in MS

Practice address

6399 Goodman Rd
Suite 108
Olive Branch, MS 38654-7070

Phone

(901) 652-0413

NPI assigned

Jun 14, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Olive Branch, MS
  • NPI 1467728006
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736380800000",
    "number": "1811930134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6399 GOODMAN RD",
            "address_2": "SUITE 108",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386547070",
            "telephone_number": "901-652-0413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6399 GOODMAN RD",
            "address_2": "SUITE 108",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386547070",
            "telephone_number": "901-652-0413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "MARCUS",
        "middle_name": "SHANNON",
        "credential": "PT ATC LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT2745",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MS",
            "license": "AT0383",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD PIN",
            "identifier": "P00190587",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00125663",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD GROUP",
            "identifier": "DC7950",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Hicks Kempe, M.D.
• Mary Catherine Key, CST,CSFA
• Joyce Denice Kildow, PA-C
• Kathleen Elizabeth Kimball, PHARM. D.
• Mollie Jo Kinard, FNP-C
• Paul King, MD
• Tiffany Shawna King, DDS
• Scott Wood Kirsch, MD
• Klepzig Smith Inc
• Jana Klepzig, RPH

• Physical Therapist in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.