Individual
MR. MARK ALAN KOOTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
6190 GEORGETOWN BLVD, SUITE 108, ELDERSBURG, MD 21784-6460
(410) 552-4235
(410) 552-4248
Mailing address
412 MALCOLM DR STE 200, WESTMINSTER, MD 21157-6174
(410) 751-7930
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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