Healthcare Provider Details

I. General information

NPI: 1609171354
Provider Name (Legal Business Name): NICOLA J POOLE-JONES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLA J POOLE

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1837 HOMER M ADAMS PKWY STE M
ALTON IL
62002-5665
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 618-208-3310
  • Fax: 618-208-3315
Mailing address:
  • Phone: 630-575-6250
  • Fax: 630-928-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070018186
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: