Provider Demographics
NPI:1649914557
Name:POLOHONKI, KAYLEE MAE (PTA)
Entity type:Individual
Prefix:MRS
First Name:KAYLEE
Middle Name:MAE
Last Name:POLOHONKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:KAYLEE
Other - Middle Name:MAE
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:10381 S EAGLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-8635
Mailing Address - Country:US
Mailing Address - Phone:814-591-6376
Mailing Address - Fax:
Practice Address - Street 1:1950 CLIFFSIDE DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7662
Practice Address - Country:US
Practice Address - Phone:814-238-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE012167225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant