Provider Demographics
NPI:1942449160
Name:DEPOOL, EDGAR JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:JOSEPH
Last Name:DEPOOL
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 1:104 SE LONITA ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3447
Mailing Address - Country:US
Mailing Address - Phone:772-463-2344
Mailing Address - Fax:772-463-9565
Practice Address - Street 1:104 SE LONITA ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3447
Practice Address - Country:US
Practice Address - Phone:772-463-2344
Practice Address - Fax:772-463-9565
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0012070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist