Provider Demographics
NPI:1962617290
Name:TOOLE, DOUGLAS B (PT)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:B
Last Name:TOOLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 SOUTH 50 EAST
Mailing Address - Street 2:P.O. BOX 405
Mailing Address - City:COALVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84017
Mailing Address - Country:US
Mailing Address - Phone:435-336-9355
Mailing Address - Fax:435-336-9356
Practice Address - Street 1:142 SOUTH 50 EAST
Practice Address - Street 2:
Practice Address - City:COALVILLE
Practice Address - State:UT
Practice Address - Zip Code:84017
Practice Address - Country:US
Practice Address - Phone:435-645-8466
Practice Address - Fax:435-615-7388
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT103506-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist