Provider Demographics
NPI:1164892030
Name:POOL, TARA (DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:POOL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100210 OVERSEAS HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2526
Mailing Address - Country:US
Mailing Address - Phone:618-838-0903
Mailing Address - Fax:
Practice Address - Street 1:100210 OVERSEAS HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2526
Practice Address - Country:US
Practice Address - Phone:305-453-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-04
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist