Healthcare Provider Details

I. General information

NPI: 1982155305
Provider Name (Legal Business Name): CARINA POLANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 N COMMERCE PKWY STE 1
WESTON FL
33326-3252
US

IV. Provider business mailing address

1029 DAISY LN
WESTON FL
33327-2443
US

V. Phone/Fax

Practice location:
  • Phone: 954-356-2878
  • Fax:
Mailing address:
  • Phone: 954-560-8507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 27126
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: