Individual
OLIVIA GAYLE KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
47 S FOURTH ST, ROLLING FORK, MS 39159-5146
(662) 873-6051
(601) 607-1379
Mailing address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8560
TN
225200000X
Physical Therapy Assistant
PTA6204
MS
Other
Enumeration date
01/19/2018
Last updated
11/15/2023
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