Provider Demographics
NPI:1093897902
Name:KOENIGS, JASON K (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:K
Last Name:KOENIGS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:1931 MARINETTE AVE
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-3801
Mailing Address - Country:US
Mailing Address - Phone:715-735-5500
Mailing Address - Fax:715-735-5502
Practice Address - Street 1:1281 MARINETTE AVE
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-2018
Practice Address - Country:US
Practice Address - Phone:715-735-5500
Practice Address - Fax:715-735-5502
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2019-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI999624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40388800Medicaid
WI40388800Medicaid