Active NPI
Ruth Jeanette Polillo
- Physical Therapist
- Lancaster, PA
National Provider Identifier
1073028775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT017991
- Practice address
- 248 Granite Run Dr
Lancaster, PA 17601-6804 - Phone
- (717) 560-2917
- Fax
- (717) 560-2985
- NPI assigned
- Dec 5, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT017991 | PA | Primary |
Addresses
Primary practice location
248 Granite Run Dr
Lancaster, PA 17601-6804
Mailing address
75 Evelyn Dr
Millersburg, PA 17061-1258
Phone (717) 692-4708
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT017991 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512432000000",
"number": "1073028775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 EVELYN DR",
"city": "MILLERSBURG",
"state": "PA",
"postal_code": "170611258",
"telephone_number": "717-692-4708",
"fax_number": "717-692-5464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "248 GRANITE RUN DR",
"city": "LANCASTER",
"state": "PA",
"postal_code": "176016804",
"telephone_number": "717-560-2917",
"fax_number": "717-560-2985"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLILLO",
"first_name": "RUTH",
"middle_name": "JEANETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-05",
"last_updated": "2017-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT017991",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lancaster, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.