Provider Demographics
NPI:1316263627
Name:KOESTNER, HANK (LMT)
Entity type:Individual
Prefix:MR
First Name:HANK
Middle Name:
Last Name:KOESTNER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:HENRY
Other - Middle Name:GEORGE
Other - Last Name:KOESTNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:185 NORTH LAKEMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792
Mailing Address - Country:US
Mailing Address - Phone:407-691-2343
Mailing Address - Fax:321-396-7667
Practice Address - Street 1:185 NORTH LAKEMONT AVENUE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792
Practice Address - Country:US
Practice Address - Phone:407-691-2343
Practice Address - Fax:321-396-7667
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0016590225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist