Provider Demographics
NPI:1740374073
Name:POLK REHABILITATION INC
Entity type:Organization
Organization Name:POLK REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:KALOGRIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:863-679-3545
Mailing Address - Street 1:1326 STATE ROAD 60 E STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4322
Mailing Address - Country:US
Mailing Address - Phone:863-679-3545
Mailing Address - Fax:863-679-3924
Practice Address - Street 1:1326 STATE ROAD 60 E STE 200
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4322
Practice Address - Country:US
Practice Address - Phone:863-679-3545
Practice Address - Fax:863-679-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14814225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684558Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER