=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235334418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KOOP PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2007
-----------------------------------------------------
Last Update Date | 03/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2701 S HWY 183, SUITE D
-----------------------------------------------------
City | LEANDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78641-2366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-259-5667
-----------------------------------------------------
Fax | 512-259-4573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2701 S HWY 183, SUITE D
-----------------------------------------------------
City | LEANDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78641-2366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-259-5667
-----------------------------------------------------
Fax | 512-259-4573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MRS. NIKI L KOOP
-----------------------------------------------------
Credential | P.T., D.P.T.
-----------------------------------------------------
Telephone | 512-259-5667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------