Individual
TRACY KIMBERLY KOONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2035 DEER TRAIL, WARSAW, IN 46580
(574) 268-5229
Mailing address
2035 DEER TRAIL, WARSAW, IN 46580
(574) 268-5229
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37001121A
IN
Other
Enumeration date
03/28/2007
Last updated
07/08/2007
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