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1952385163
SHANE LOWELL KOPPENHAVER
FORT SAM HOUSTON, TX
NPI
1952385163
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2251X0800X Physical Therapist, Orthopedic
(Licence: VA 2305006682)
Enumeration Date
2005-12-01
Last Update Date
2007-07-08
Business Address
Mr. SHANE LOWELL KOPPENHAVER MPT, OCS
3851 ROGER BROOKE DR (BAMC MCHE-QD/ CREDENTIALS)
FORT SAM HOUSTON, TX 78234-4501
Phone number: 210-916-1920
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Mailing Address
Mr. SHANE LOWELL KOPPENHAVER MPT, OCS
424 NORMANDY AVE
SAN ANTONIO, TX 78209-4543
Phone number:
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