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General NPI Number Information
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NPI Number | 1689100927
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Entity Type | Individual
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Provider Name | JUSTIN KOENIG DPT
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Gender | Male
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 1000 BROADWAY SUITE 500
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City | OAKLAND
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State | CA
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Zip | 94607-4099
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Country | US
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Telephone | 510-208-1011
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 925
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City | GLEN ELLEN
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State | CA
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Zip | 95442-0925
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Country | US
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Telephone | 510-334-0278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 24946
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License Number State | CA
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