Provider Demographics
NPI:1487886529
Name:POLEET, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:POLEET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-2092
Mailing Address - Country:US
Mailing Address - Phone:618-531-6391
Mailing Address - Fax:
Practice Address - Street 1:100 S WESLEY DR
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-2092
Practice Address - Country:US
Practice Address - Phone:618-531-6391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2251225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant