Theresa Ynez B Polistico, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1328824 Issued in WI

Practice address

1101 E South River St
Appleton, WI 54915-2223

Phone

(920) 445-3132

NPI assigned

Jun 23, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• PRN Home Health & Therapy, LLC

  • Home Health Agency
  • Appleton, WI
  • NPI 1396111068
  NPD

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

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609632000000",
    "number": "1356967558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 E SOUTH RIVER ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549152223",
            "telephone_number": "920-830-9911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 E SOUTH RIVER ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549152223",
            "telephone_number": "920-445-3132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLISTICO",
        "first_name": "THERESA YNEZ",
        "middle_name": "B",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-23",
        "last_updated": "2021-01-03",
        "certification_date": "2021-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1251920",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "1328824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Poitras
• Meredith Pokel, OTR/L
• Polar Physical Therapy, LLC
• Brooke Polcyn, M.S.
• Amy E Poliak, NP
• Michael D Polka, M.D.
• Jordan Faith Polley, FNP-C
• J Scott Polzin, DDS
• Jeremy Alan Pomplun, PA-C
• Lindsey Leanna Pomputis

• Physical Therapist in Appleton, WI
• Providers in Appleton, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2021; 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.