Healthcare Provider Details

I. General information

NPI: 1699540997
Provider Name (Legal Business Name): POLEN URAL RADZISZEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: POLEN URAL

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 SW 75TH AVE
MIAMI FL
33155-2800
US

IV. Provider business mailing address

3880 BIRD RD APT 414
MIAMI FL
33146-1539
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-6800
  • Fax:
Mailing address:
  • Phone: 617-275-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTT40969
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: