Provider Demographics
NPI:1992844534
Name:KOENIG, KATHLEEN MAURA (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MAURA
Last Name:KOENIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MAURA
Other - Last Name:DESMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7215 116TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98056-1102
Mailing Address - Country:US
Mailing Address - Phone:360-474-3192
Mailing Address - Fax:425-278-0628
Practice Address - Street 1:7215 116TH AVE SE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98056
Practice Address - Country:US
Practice Address - Phone:360-474-3192
Practice Address - Fax:425-278-0628
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010688225100000X
WA60229092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist