Provider Demographics
NPI:1588009799
Name:POOLE, CYNTHIA LEAGUE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LEAGUE
Last Name:POOLE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:163 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-9912
Mailing Address - Country:US
Mailing Address - Phone:706-282-4461
Mailing Address - Fax:706-282-4416
Practice Address - Street 1:163 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-9912
Practice Address - Country:US
Practice Address - Phone:706-282-4461
Practice Address - Fax:706-282-4416
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist