Provider Demographics
NPI:1902475882
Name:POOL, SPENCER (LMT)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:POOL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 W 650 S UNIT D308
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-6057
Mailing Address - Country:US
Mailing Address - Phone:801-362-8345
Mailing Address - Fax:
Practice Address - Street 1:730 S SLEEPY RIDGE DR STE 312
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84059-2614
Practice Address - Country:US
Practice Address - Phone:801-362-8345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11686318-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist