Individual
MR. MARK ALAN KOOTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
17624
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023348001
—
MD
01
—
3201864
AETNA
MD
01
—
36948
JHHC
MD
01
—
382668
MAMSI
MD
01
—
4368142
AETNA
MD
01
—
4761-0101
BCBS
—
01
—
53024404
BCBS
MD
Enumeration date
04/25/2006
Last updated
12/20/2023
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