Provider Demographics
NPI:1194873331
Name:POOLE, JOANNE MARY (PT)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARY
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 1:5908 E 1050 S
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:IN
Mailing Address - Zip Code:47355-8914
Mailing Address - Country:US
Mailing Address - Phone:765-277-0472
Mailing Address - Fax:765-874-1784
Practice Address - Street 1:5908 E 1050 S
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:IN
Practice Address - Zip Code:47355-8914
Practice Address - Country:US
Practice Address - Phone:765-277-0472
Practice Address - Fax:765-874-1784
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005197A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist