Provider Demographics
NPI:1407120587
Name:KOENIG, MICHELLE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:KOENIG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 1ST AVE S
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW ROCKFORD
Mailing Address - State:ND
Mailing Address - Zip Code:58356-1800
Mailing Address - Country:US
Mailing Address - Phone:701-302-0325
Mailing Address - Fax:
Practice Address - Street 1:207 1ST AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:NEW ROCKFORD
Practice Address - State:ND
Practice Address - Zip Code:58356-1800
Practice Address - Country:US
Practice Address - Phone:701-302-0325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND841225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist