Provider Demographics
NPI:1649379348
Name:POOLE, ANDY (PT)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:POOLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GREEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-2654
Mailing Address - Country:US
Mailing Address - Phone:540-213-1201
Mailing Address - Fax:540-213-1204
Practice Address - Street 1:1 GREEN HILL DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-2654
Practice Address - Country:US
Practice Address - Phone:540-213-1201
Practice Address - Fax:540-213-1204
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA465564OtherANTHEM