Lisa D King, LMT, RYT
Individual provider Active NPI Specialist · Niantic, CT
NPI 1982015905 · NPPES record last updated May 13, 2014
Key facts
- NPI
- 1982015905
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 006640 (CT)
- Practice address
- 321 Main St Ste 7&8
Niantic, CT 06357-3127 - Phone
- (860) 440-6418
- NPI assigned
- May 13, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 006640 | CT | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 006640 | CT | Yes |
Addresses
Primary practice location
321 Main St Ste 7&8
Niantic, CT 06357-3127
Mailing address
321 Main St Ste 7&8
Niantic, CT 06357-3127
Phone (860) 440-6418
Other providers in Niantic, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2014. 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.