Provider Demographics
NPI:1417217696
Name:KOENIG, SARAH ANN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:ANN
Last Name:KOENIG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 US HIGHWAY 221A
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-5912
Mailing Address - Country:US
Mailing Address - Phone:828-980-5493
Mailing Address - Fax:
Practice Address - Street 1:518 OLD US 221 HWY
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-8670
Practice Address - Country:US
Practice Address - Phone:828-287-7655
Practice Address - Fax:828-287-4459
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4789225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant