Provider Demographics
NPI:1598032120
Name:KOONS, SANDRA ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:KOONS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6511 W LOOP 1604 N
Mailing Address - Street 2:SUITE117
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5438
Mailing Address - Country:US
Mailing Address - Phone:210-201-0185
Mailing Address - Fax:210-688-9228
Practice Address - Street 1:6511 W LOOP 1604 N
Practice Address - Street 2:SUITE117
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5438
Practice Address - Country:US
Practice Address - Phone:210-201-0185
Practice Address - Fax:210-688-9228
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011037089225100000X
TX1236350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1972761187OtherMEDICARE GROUP NPI
MO40414014OtherBLUE CROSS BLUE SHIELD GROUP
MOMA1030OtherMEDICARE GROUP PTAN