Kelly Ann Polivka, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

15123 Issued in TN

Practice address

980 Poplar Ave
Memphis, TN 38105-4614

Phone

(901) 287-4300

NPI assigned

Aug 15, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fiat Physical Therapy

  • Physical Therapy Clinic/Center
  • Bartlett, TN
  • NPI 1629736632

  Physical Therapist

  NPD (past)
• Origin Physical Therapy FL PLLC

  • Physical Therapist
  • Austin, TX
  • NPI 1477220861
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1083497895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "364 TARAVIEW RD",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380171938",
            "telephone_number": "630-991-7061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 POPLAR AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381054614",
            "telephone_number": "901-287-4300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4110 Minden Rd",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381171516",
            "country_code": "US",
            "telephone_number": "901-482-3997",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLIVKA",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-15",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "15123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Pointer, CRNA
• Yasmina Pokharel, MD
• Hiren Sampatraj Pokharna, M.D.
• Tyler Andrew Polanco
• Jason Poletti
• Temesha Evette Polk-Howard, MSW,LCSW
• Angela Mi Polk
• Erica Polk, D.D.S.
• Kimberly Dawn Polk, APN
• Lakesha Polk, HAIR LOSS SPECIALIST

• Physical Therapist in Memphis, TN
• Providers in Memphis, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.