Provider Demographics
NPI:1174168694
Name:KING, MARIAH WEBER (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:MARIAH
Middle Name:WEBER
Last Name:KING
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:MARIAH
Other - Middle Name:IDA
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:15375 BARRANCA PKWY STE A103
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2203
Mailing Address - Country:US
Mailing Address - Phone:949-590-9350
Mailing Address - Fax:949-346-5350
Practice Address - Street 1:15375 BARRANCA PKWY STE A103
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2203
Practice Address - Country:US
Practice Address - Phone:949-590-9350
Practice Address - Fax:949-346-5350
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist