Provider Demographics
NPI:1124331525
Name:POOLE, CARRIE ELIZABETH (PT)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:POOLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-7947
Mailing Address - Country:US
Mailing Address - Phone:860-718-1727
Mailing Address - Fax:
Practice Address - Street 1:225 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:WEATOGUE
Practice Address - State:CT
Practice Address - Zip Code:06089-9782
Practice Address - Country:US
Practice Address - Phone:860-651-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist