Provider Demographics
NPI:1235428079
Name:POOL, STEPHANIE (MES)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:POOL
Suffix:
Gender:F
Credentials:MES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 ATLANTIS
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5851
Mailing Address - Country:US
Mailing Address - Phone:512-850-8453
Mailing Address - Fax:512-879-6882
Practice Address - Street 1:121 HALL PROFESSIONAL CTR
Practice Address - Street 2:SUITE D
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-8962
Practice Address - Country:US
Practice Address - Phone:512-850-8453
Practice Address - Fax:512-879-6882
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner