Provider Demographics
NPI:1235334418
Name:KOOP PHYSICAL THERAPY
Entity Type:Organization
Organization Name:KOOP PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOOP
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:512-259-5667
Mailing Address - Street 1:2701 S HWY 183, SUITE D
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2366
Mailing Address - Country:US
Mailing Address - Phone:512-259-5667
Mailing Address - Fax:512-259-4573
Practice Address - Street 1:2701 S HWY 183, SUITE D
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-2366
Practice Address - Country:US
Practice Address - Phone:512-259-5667
Practice Address - Fax:512-259-4573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX714081OtherACN GROUP
TX2334512OtherCIGNA
TX0041PQOtherBCBS
TX0041PQOtherBCBS