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NPI Code Detail

MEDICARE: MRS. KATIE MW POOLE PTA

MEDICARE: MRS. KATIE MW POOLE PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant3119NC

General Provider Information

NPI Number : 1326343294
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATIE MW POOLE PTA
Provider Business Mailing Address
First Line : 2601 REYNOLDA RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27106-3863
Country : US
Telephone Number : 336-331-3405
Fax Number : 336-331-3405
Provider Business Practice Location Address
First Line : 2601 REYNOLDA RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27106-3863
Country : US
Telephone Number : 336-331-3405
Fax Number : 336-331-3405
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2011
Last Update Date : 01/24/2011

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