Provider Demographics
NPI:1003878406
Name:KOENIG, JULIE WELLS (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:WELLS
Last Name:KOENIG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 RIVER OAKS RD
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8051
Mailing Address - Country:US
Mailing Address - Phone:803-619-4294
Mailing Address - Fax:
Practice Address - Street 1:4012 PARK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2377
Practice Address - Country:US
Practice Address - Phone:704-332-4834
Practice Address - Fax:704-372-9653
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87982251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics