Provider Demographics
NPI:1467504134
Name:POOLE, ROSALYN (DPT)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:POOLE
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 1:223 CHANTILLY CIR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6587
Mailing Address - Country:US
Mailing Address - Phone:501-428-8778
Mailing Address - Fax:
Practice Address - Street 1:1635 HIGDON FERRY RD
Practice Address - Street 2:SUITE A
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6913
Practice Address - Country:US
Practice Address - Phone:501-476-2770
Practice Address - Fax:501-781-2234
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT29202251P0200X
ARPT 2920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161462721Medicaid
AR161462721Medicaid