Provider Demographics
NPI:1164014544
Name:POOLE, PRESTON (DPT)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:
Last Name:POOLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 OCEAN VIEW BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1409
Mailing Address - Country:US
Mailing Address - Phone:818-369-7620
Mailing Address - Fax:818-369-7621
Practice Address - Street 1:4515 OCEAN VIEW BLVD STE 350
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-1409
Practice Address - Country:US
Practice Address - Phone:818-369-7620
Practice Address - Fax:818-369-7621
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA299870OtherPHYSICAL THERAPY LICENSE NUMBER