Provider Demographics
NPI:1255324570
Name:KOENIG, SUSAN (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KOENIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CORPORATE PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3865
Mailing Address - Country:US
Mailing Address - Phone:978-535-1213
Mailing Address - Fax:978-535-5510
Practice Address - Street 1:100 CORPORATE PL
Practice Address - Street 2:SUITE 103
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3865
Practice Address - Country:US
Practice Address - Phone:978-535-1213
Practice Address - Fax:978-535-5510
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA63652251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2976291OtherAETNA
MA333402OtherTUFTS
MA626323OtherHARVARD PILGRIM
MA0365092Medicaid
MAY66774OtherBLUE CROSS BLUE SHIELD
MA626323OtherHARVARD PILGRIM