Provider Demographics
NPI:1598867277
Name:POOLE, SHANNON TRALEE (MS,LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:TRALEE
Last Name:POOLE
Suffix:
Gender:F
Credentials:MS,LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 SHALLOWBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2991
Mailing Address - Country:US
Mailing Address - Phone:919-850-8896
Mailing Address - Fax:919-850-8803
Practice Address - Street 1:2201 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-7536
Practice Address - Country:US
Practice Address - Phone:919-850-8896
Practice Address - Fax:919-850-8803
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer