Individual
TORRE ANNETTE KOONTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
918 N 1550 EAST RD, LAKEWOOD, IL 62438-4051
(217) 827-3820
Mailing address
918 N 1550 EAST RD, LAKEWOOD, IL 62438-4051
(217) 827-3820
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2023
Last updated
06/26/2023
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