1598032120 NPI number — SANDRA ANN KOONS PT, DPT

Table of content: MRS. VIRGINIA L VAN ES M.S.,CCC-SLP (NPI 1841447521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598032120 NPI number — SANDRA ANN KOONS PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOONS
Provider First Name:
SANDRA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598032120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6511 W LOOP 1604 N
Provider Second Line Business Mailing Address:
SUITE117
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78254-5438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-201-0185
Provider Business Mailing Address Fax Number:
210-688-9228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6511 W LOOP 1604 N
Provider Second Line Business Practice Location Address:
SUITE117
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78254-5438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-201-0185
Provider Business Practice Location Address Fax Number:
210-688-9228
Provider Enumeration Date:
11/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2011037089 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 1236350 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1972761187 . This is a "MEDICARE GROUP NPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 40414014 . This is a "BLUE CROSS BLUE SHIELD GROUP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: MA1030 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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