Provider Demographics
NPI:1831672401
Name:POOLEY, DESIREE (CMT)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:POOLEY
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 PEAR LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-7672
Mailing Address - Country:US
Mailing Address - Phone:707-410-8766
Mailing Address - Fax:
Practice Address - Street 1:5850 COMMERCE BLVD STE C2
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-1621
Practice Address - Country:US
Practice Address - Phone:707-430-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68238225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist