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General NPI Number Information
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NPI Number | 1730206467
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Entity Type | Individual
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Provider Name | PETER G KALOGRIDIS II MPT
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1326 STATE ROAD 60 E STE 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 | 863-679-3924
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Provider Business Mailing Address
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Address Line | PO BOX 1378
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City | WINTER HAVEN
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State | FL
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Zip | 33882-1378
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Country | US
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Telephone | 863-289-2322
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Fax | 863-679-3924
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT14814
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License Number State | FL
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