Provider Demographics
NPI:1275888166
Name:KOENIG, LAURA J (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
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 1:1287 EDWARDS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4054
Mailing Address - Country:US
Mailing Address - Phone:830-708-9636
Mailing Address - Fax:972-771-2281
Practice Address - Street 1:1287 EDWARDS BLVD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4054
Practice Address - Country:US
Practice Address - Phone:830-708-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1219370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist