Provider Demographics
NPI:1023488962
Name:KING, SETH (DPT)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3667
Mailing Address - Country:US
Mailing Address - Phone:517-499-1213
Mailing Address - Fax:
Practice Address - Street 1:1928 STAR BATT DR STE A
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3722
Practice Address - Country:US
Practice Address - Phone:248-289-1168
Practice Address - Fax:248-289-1435
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010174542251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic