Provider Demographics
NPI:1699540997
Name:URAL RADZISZEWSKI, POLEN
Entity type:Individual
Prefix:
First Name:POLEN
Middle Name:
Last Name:URAL RADZISZEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:POLEN
Other - Middle Name:
Other - Last Name:URAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3880 BIRD RD APT 414
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1539
Mailing Address - Country:US
Mailing Address - Phone:617-275-1115
Mailing Address - Fax:
Practice Address - Street 1:2525 SW 75TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2800
Practice Address - Country:US
Practice Address - Phone:305-262-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT40969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist