Healthcare Provider Details

I. General information

NPI: 1851599757
Provider Name (Legal Business Name): THERESA ANN KOENIG L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14780 SW OSPREY DR SUITE NUMBER 350
BEAVERTON OR
97007-8028
US

IV. Provider business mailing address

14780 SW OSPREY DR SUITE NUMBER 350
BEAVERTON OR
97007-8028
US

V. Phone/Fax

Practice location:
  • Phone: 503-579-6038
  • Fax:
Mailing address:
  • Phone: 503-579-6038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5034
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: