Provider Demographics
NPI:1588995526
Name:POOLE, KARMA RENEE (PTA)
Entity type:Individual
Prefix:MRS
First Name:KARMA
Middle Name:RENEE
Last Name:POOLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:KARMA
Other - Middle Name:RENEE
Other - Last Name:GEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:4610 ZOLTAN DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-2832
Mailing Address - Country:US
Mailing Address - Phone:321-264-0368
Mailing Address - Fax:
Practice Address - Street 1:4610 ZOLTAN DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-2832
Practice Address - Country:US
Practice Address - Phone:321-264-0368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 15486225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant