Provider Demographics
NPI:1174595052
Name:KING, MARJORIE ANN (PHD, ATC, PT)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:PHD, ATC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-0248
Mailing Address - Country:US
Mailing Address - Phone:603-535-3108
Mailing Address - Fax:
Practice Address - Street 1:17 HIGH ST
Practice Address - Street 2:MSC 22 PLYMOUTH STATE UNIVERSITY
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-1595
Practice Address - Country:US
Practice Address - Phone:603-535-3108
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer