Provider Demographics
NPI:1528391687
Name:KOERNER, DANA MARIE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MARIE
Last Name:KOERNER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:544 CLIFTON BLUE ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6175
Mailing Address - Country:US
Mailing Address - Phone:919-610-8852
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-6827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist