Individual
CARRIE KOOYENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1663 BELVIDERE RD, BELVIDERE, IL 61008-9306
(815) 544-0040
(815) 544-0048
Mailing address
10100 FOREST HILLS RD, MACHESNEY PARK, IL 61115-8234
(815) 713-2742
(815) 282-8597
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.005053
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160.005053
STATE OF ILLINOIS LICENSE
IL
Enumeration date
09/19/2008
Last updated
09/19/2008
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