Provider Demographics
NPI:1235228065
Name:POOLE, ROBERT M (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:POOLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:917 EAGLES LANDING PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5011
Mailing Address - Country:US
Mailing Address - Phone:770-506-6993
Mailing Address - Fax:770-506-6994
Practice Address - Street 1:909 EAGLES LANDING PKWY STE 430
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6398
Practice Address - Country:US
Practice Address - Phone:770-506-6993
Practice Address - Fax:770-506-6994
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS84523Medicare UPIN
GA65BBCHVMedicare ID - Type Unspecified