Provider Demographics
NPI:1497114367
Name:KOENKE, ERIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:KOENKE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:KLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2121 E WILLIAMS ST STE 108
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-7765
Mailing Address - Country:US
Mailing Address - Phone:919-372-8412
Mailing Address - Fax:919-267-6556
Practice Address - Street 1:570 NEW WAVERLY PL STE 120
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7405
Practice Address - Country:US
Practice Address - Phone:919-803-3398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist