MEDICARE: ROBERT POOLOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT009457	OH

General Provider Information

NPI Number	:	1750336418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT POOLOS

Provider Business Mailing Address
First Line	:	4041 W SYLVANIA AVE
Second Line	:	SUITE L004 TOLEDO ORTHOPEDIC REHABILITATION
City	:	TOLEDO
State	:	OH
Zip	:	43623-4465
Country	:	US
Telephone Number	:	419-474-4781
Fax Number	:	419-474-8372

Provider Business Practice Location Address
First Line	:	4041 W SYLVANIA AVE
Second Line	:	SUITE L004 TOLEDO ORTHOPEDIC REHABILITATION
City	:	TOLEDO
State	:	OH
Zip	:	43623-4465
Country	:	US
Telephone Number	:	419-474-4781
Fax Number	:	419-474-8372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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