MEDICARE: MR. NICHOLAS KENT POOLER PT

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
1	225100000X	Physical Therapist	PT19064	FL

General Provider Information

NPI Number	:	1780080671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS KENT POOLER PT

Provider Business Mailing Address
First Line	:	220 E CENTRAL PKWY STE 2070
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3419
Country	:	US
Telephone Number	:	407-647-5008
Fax Number	:	407-647-5299

Provider Business Practice Location Address
First Line	:	220 E CENTRAL PKWY STE 2070
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3419
Country	:	US
Telephone Number	:	407-647-5008
Fax Number	:	407-647-5299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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