Provider Demographics
NPI:1396226098
Name:MOONEY, KATARZYNA KONOPKA (DPT)
Entity Type:Individual
Prefix:
First Name:KATARZYNA
Middle Name:KONOPKA
Last Name:MOONEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CIRCLE 75 PKWY SE STE 1400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3067
Mailing Address - Country:US
Mailing Address - Phone:678-981-3543
Mailing Address - Fax:404-777-1311
Practice Address - Street 1:630 CRANE CREEK DR STE 106
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-0004
Practice Address - Country:US
Practice Address - Phone:626-854-2777
Practice Address - Fax:762-685-4275
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT013564OtherSTATE PT LICENSE