Individual
NIKKI POOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
9909 E 100 S, GREENTOWN, IN 46936-9163
(765) 628-0605
(765) 628-3639
Mailing address
9909 E 100 S, GREENTOWN, IN 46936-9163
(765) 628-0605
(765) 628-3639
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
06001474
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200844350
—
IN
Enumeration date
05/05/2008
Last updated
05/05/2008
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