Koontz, Alicia
Koontz, Alicia is an sole proprietor health care provider with primary practice located at 102 W Kenwood Ave , Decatur IL 62526-4368. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Koontz, Alicia can be contacted via phone (217) 876-2690.Contact Information
Primary practice address
102 W Kenwood Ave
Decatur IL 62526-4368
Phone: (217) 876-2690
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant | 225200000X |
Profile Details
| NPI number | 1932464633 |
|---|---|
| LBN Legal business name | Koontz, Alicia |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 9th, 2012 |
| Last updated | Jul 9th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932464633 | NPPES |
| Illinois | MEDICAID | 160005000 |
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