Provider Demographics
NPI:1679374391
Name:KING, SKYLAR
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:
Last Name:KING
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 LAKE HARDEMAN RD
Mailing Address - Street 2:
Mailing Address - City:SAULSBURY
Mailing Address - State:TN
Mailing Address - Zip Code:38067-7636
Mailing Address - Country:US
Mailing Address - Phone:731-433-7403
Mailing Address - Fax:
Practice Address - Street 1:535 MARSAILLES RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1911
Practice Address - Country:US
Practice Address - Phone:859-879-3560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist