Individual
MR. SHANE LOWELL KOPPENHAVER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MPT, OCS
Contact information
Practice address
3851 ROGER BROOKE DR, (BAMC MCHE-QD/ CREDENTIALS), FORT SAM HOUSTON, TX 78234-4501
(210) 916-1920
Mailing address
424 NORMANDY AVE, SAN ANTONIO, TX 78209-4543
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
2305006682
VA
Other
Enumeration date
12/01/2005
Last updated
07/08/2007
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