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General NPI Number Information
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NPI Number | 1376712307
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Entity Type | Organization
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Legal Business Name | POLK REHABILITATION INC
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 1326 STATE ROAD 60 E SUITE 200
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City | LAKE WALES
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State | FL
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Zip | 33853-4322
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Country | US
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Telephone | 863-679-3545
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Fax |
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Provider Business Mailing Address
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Address Line | 1326 STATE ROAD 60 E SUITE 200
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City | LAKE WALES
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State | FL
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Zip | 33853-4322
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Country | US
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Telephone | 863-679-3545
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOLANDA LUIS FUENTES
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Credential |
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Telephone | 786-370-4835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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