Provider Demographics
NPI:1669162855
Name:KING, CHARITY L (PTA)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 JACKSBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:LAFOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766
Mailing Address - Country:US
Mailing Address - Phone:423-566-2250
Mailing Address - Fax:423-566-5896
Practice Address - Street 1:2458 JACKSBORO PIKE
Practice Address - Street 2:
Practice Address - City:LAFOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766
Practice Address - Country:US
Practice Address - Phone:423-566-2250
Practice Address - Fax:423-566-5896
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000007152225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant