Provider Demographics
NPI:1770684201
Name:POLOSKEY, LAURIE (PT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:POLOSKEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18786 CAPE SABLE DR.
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498
Mailing Address - Country:US
Mailing Address - Phone:561-487-1905
Mailing Address - Fax:
Practice Address - Street 1:18786 CAPE SABLE DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6376
Practice Address - Country:US
Practice Address - Phone:561-487-1905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4683BMedicare ID - Type UnspecifiedPROVIDER NUMBER