Provider Demographics
NPI:1144180373
Name:KING, ANDREW CASSADY JR (DPT)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CASSADY
Last Name:KING
Suffix:JR
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 1:2110 E 16TH ST APT Q303
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-5990
Mailing Address - Country:US
Mailing Address - Phone:530-933-0230
Mailing Address - Fax:
Practice Address - Street 1:3100 W WARNER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5331
Practice Address - Country:US
Practice Address - Phone:714-546-4233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA309126OtherPTBCA