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General NPI Number Information
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NPI Number | 1346206679
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Entity Type | Individual
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Provider Name | MARK ALAN KOOTZ PT
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 6190 GEORGETOWN BLVD SUITE 108
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City | ELDERSBURG
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State | MD
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Zip | 21784-6460
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Country | US
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Telephone | 410-552-4235
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Fax | 410-552-4248
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Provider Business Mailing Address
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Address Line | 412 MALCOLM DR STE 200
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City | WESTMINSTER
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State | MD
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Zip | 21157-6174
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Country | US
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Telephone | 410-751-7930
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Fax |
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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 | 17624
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License Number State | MD
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