Provider Demographics
NPI:1245950906
Name:KOONTZ, JAMES ATTICUS
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ATTICUS
Last Name:KOONTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4234 E MERCER WAY
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3824
Mailing Address - Country:US
Mailing Address - Phone:206-605-3011
Mailing Address - Fax:
Practice Address - Street 1:9801 FRONTIER AVE SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-5200
Practice Address - Country:US
Practice Address - Phone:425-831-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist