Provider Demographics
NPI:1346750379
Name:KOENIG, ALLISON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:KOENIG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 KANANI RD
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-6805
Mailing Address - Country:US
Mailing Address - Phone:808-633-4480
Mailing Address - Fax:866-465-8155
Practice Address - Street 1:2758 N GALLOWAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6381
Practice Address - Country:US
Practice Address - Phone:972-681-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23315225100000X
HIPT-5314225100000X
TX1312038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist