Provider Demographics
NPI:1225141344
Name:POOLE, KRISTEN P (PT)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:P
Last Name:POOLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3766
Mailing Address - Country:US
Mailing Address - Phone:781-229-8011
Mailing Address - Fax:781-229-8374
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 121Q
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-927-0907
Practice Address - Fax:978-927-0537
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0708682Medicaid
MA0708682Medicaid