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General NPI Number Information
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NPI Number | 1336488352
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Entity Type | Individual
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Provider Name | SARAI POLANCO
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Gender | Female
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Dates
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Enumeration Date | 02/11/2013
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Last Update Date | 02/11/2013
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Provider Practice Location Address
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Address Line | 2600 BARRACKS RD
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-2271
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Country | US
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Telephone | 434-963-4198
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Fax |
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Provider Business Mailing Address
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Address Line | 20261 SW 316TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33030-5111
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Country | US
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Telephone | 305-613-5367
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306603439
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License Number State | VA
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