Provider Demographics
NPI:1700290970
Name:KONING, STEFANIE DAWN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:DAWN
Last Name:KONING
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 1:8505 WOODFIELD CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-4309
Mailing Address - Country:US
Mailing Address - Phone:317-466-2020
Mailing Address - Fax:317-466-2024
Practice Address - Street 1:8505 WOODFIELD CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4309
Practice Address - Country:US
Practice Address - Phone:317-466-2020
Practice Address - Fax:317-466-2024
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001158A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant