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General NPI Number Information
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NPI Number | 1336546092
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Entity Type | Individual
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Provider Name | DESIRAE KOONCE DPT
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Gender | Female
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 275 SE CABOT DR SUITE A-05
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City | OAK HARBOR
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State | WA
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Zip | 98277-3715
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Country | US
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Telephone | 360-914-5504
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Fax | 360-639-4079
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Provider Business Mailing Address
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Address Line | 4220 132ND ST SE SUITE 101
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City | MILL CREEK
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State | WA
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Zip | 98012-8999
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Country | US
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Telephone | 425-357-9380
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Fax | 425-357-9382
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 15174
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60729955
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License Number State | WA
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