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General NPI Number Information
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NPI Number | 1740093483
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Entity Type | Individual
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Provider Name | KRISTIAN POOLER MASSAGE THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1595 CORNERSTONE CT STE A
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City | BEAUMONT
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State | TX
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Zip | 77706-4066
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Country | US
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Telephone | 409-833-3080
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Fax |
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Provider Business Mailing Address
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Address Line | 710 AVENUE B
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City | PORT NECHES
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State | TX
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Zip | 77651-2806
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Country | US
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Telephone | 509-294-2242
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT142602
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License Number State | TX
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