Organization
AVA REHABILITATION CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. POLA GAYED DPT (OWNER)
(863) 676-8300
Entity
Organization
Contact information
Practice address
1342 STATE ROAD 60 E, LAKE WALES, FL 33853-4322
(863) 676-8300
(863) 676-1300
Mailing address
1342 STATE ROAD 60 E, LAKE WALES, FL 33853-4322
(863) 676-8300
(863) 676-1300
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT3913
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD6113
RAILROAD MEDICARE
—
Enumeration date
05/26/2006
Last updated
01/13/2021
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