Provider Demographics
NPI:1346430733
Name:KOOP, NIKI L (PT)
Entity Type:Individual
Prefix:MRS
First Name:NIKI
Middle Name:L
Last Name:KOOP
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 1:2701 S HIGHWAY 183 STE 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 HIGHWAY 183 STE 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
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10989112251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX714081OtherACN GROUP
TX2334512OtherCIGNA
TX8T7255OtherBCBS
TX108026903Medicaid
TX8T7255OtherBCBS