Provider Demographics
NPI:1730206467
Name:KALOGRIDIS, PETER G II (MPT)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:KALOGRIDIS
Suffix:II
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1378
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33882-1378
Mailing Address - Country:US
Mailing Address - Phone:863-289-2322
Mailing Address - Fax:863-679-3924
Practice Address - Street 1:1326 STATE ROAD 60 E STE 200
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4322
Practice Address - Country:US
Practice Address - Phone:863-679-3545
Practice Address - Fax:863-679-3924
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist