Provider Demographics
NPI:1689036196
Name:POOL THERAPY PLUS, PLLC
Entity Type:Organization
Organization Name:POOL THERAPY PLUS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-227-2364
Mailing Address - Street 1:353 CIMARRON CT
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1563
Mailing Address - Country:US
Mailing Address - Phone:928-227-2364
Mailing Address - Fax:928-233-6932
Practice Address - Street 1:353 CIMARRON CT
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1563
Practice Address - Country:US
Practice Address - Phone:928-227-2364
Practice Address - Fax:928-233-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6690261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ1479363Medicare UPIN