Provider Demographics
NPI:1831910561
Name:POLLAROLO, JOANNA MARITZA
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARITZA
Last Name:POLLAROLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 TWIN LAKE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-3239
Mailing Address - Country:US
Mailing Address - Phone:786-495-6790
Mailing Address - Fax:
Practice Address - Street 1:2471 TWIN LAKE VIEW RD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-3239
Practice Address - Country:US
Practice Address - Phone:786-495-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA89441225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist