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General NPI Number Information
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NPI Number | 1124597232
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Entity Type | Individual
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Provider Name | CALEB POE
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Gender | Male
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 1775 WITTINGTON PLACE STE. #175
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City | DALLAS
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State | TX
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Zip | 75234
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Country | US
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Telephone | 337-263-4568
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Fax |
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Provider Business Mailing Address
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Address Line | 6464 CORBINA RD
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City | LAKE CHARLES
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State | LA
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Zip | 70607-7674
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Country | US
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Telephone | 337-263-4568
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10453R
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License Number State | CA
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