Healthcare Provider Details

I. General information

NPI: 1649379348
Provider Name (Legal Business Name): ANDY POOLE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GREEN HILL DR
VERONA VA
24482-2654
US

IV. Provider business mailing address

1 GREEN HILL DR
VERONA VA
24482-2654
US

V. Phone/Fax

Practice location:
  • Phone: 540-213-1201
  • Fax: 540-213-1204
Mailing address:
  • Phone: 540-213-1201
  • Fax: 540-213-1204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: