Individual
ANGELA M KOONIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
449 N WENDOVER RD, SUITE B, CHARLOTTE, NC 28211-1064
(704) 366-7723
(704) 366-7724
Mailing address
449 N WENDOVER RD, SUITE B, CHARLOTTE, NC 28211-1064
(704) 366-7723
(704) 366-7724
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8265
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078HK
BCBSNC
NC
05
—
7212126
—
NC
01
—
B2961
MEDCOST
NC
Enumeration date
08/01/2006
Last updated
06/28/2010
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