Individual
KELLY ANN KOENIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1376 BREAM AVE, MANNING, SC 29102-8456
(803) 460-1521
Mailing address
1376 BREAM AVE, MANNING, SC 29102-8456
(803) 460-1521
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
11/30/2018
Last updated
06/25/2021
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