| Doctor Name: | BETTY JEAN POULOS |
| NPI Number: | 1205997004 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S.P.T. |
| License Number: | 004942 |
| Business Practice Address: | 285 Sills Rd East Patchogue East Patchogue, NY - 117724808 |
| Business Phone Number: | 6314752858 |
| Business Fax Number: | 6314751588 |
| Mailing Address: | 285 Sills Rd, East Patchogue EAST PATCHOGUE |
| State: | NY |
| Postal Code: | 117724808 |
| Phone Number: | 6314752858 |
| Fax Number: | 6314752886 |
| NPI Enumeration Date: | 12/13/2006 |
| NPI Last Update Date: | 05/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 004942 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |