Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 5159 | SC |
NPI | 1053550954 |
---|---|
Provider Name | Kathleen Mull Poole |
First Address | Columbia, SC 29205-2727 |
Second Address | Columbia, SC 29205-2727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2009 |
Last Update Date | 17/02/2009 |