Provider Demographics
NPI:1205849940
Name:KOENIGSKNECHT, BARBARA ANN (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:KOENIGSKNECHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:VEALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:517-676-9788
Mailing Address - Fax:517-676-3438
Practice Address - Street 1:1507 WATERFORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-9630
Practice Address - Country:US
Practice Address - Phone:989-227-5404
Practice Address - Fax:989-227-5415
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ33901Medicare UPIN
MI0P08980Medicare ID - Type UnspecifiedMCR GROUP #
MIP08980001Medicare PIN