1225010879 NPI number — SELECT THERAPY AND REHABILITATION SERVICES

Table of content: DR. WILLIAM EMORY POLLEY JR. MD (NPI 1588683650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225010879 NPI number — SELECT THERAPY AND REHABILITATION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SELECT THERAPY AND REHABILITATION SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225010879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3157 N UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33024-2258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-443-3996
Provider Business Mailing Address Fax Number:
954-443-3994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3157 N UNIVERSITY DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024-2258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-443-3996
Provider Business Practice Location Address Fax Number:
954-443-3994
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WAGGONER
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
954-443-3996

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  FL 18303 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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