Provider Demographics
NPI:1730532342
Name:KOENIG, RILEY COLIN (ATC)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:COLIN
Last Name:KOENIG
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 COBBLESTONE WAY CT
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5402
Mailing Address - Country:US
Mailing Address - Phone:830-660-3164
Mailing Address - Fax:
Practice Address - Street 1:2129 COBBLESTONE WAY CT
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5402
Practice Address - Country:US
Practice Address - Phone:830-660-3164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer