Andrew Polenske, PT, DPT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

63710 Issued in OR

Practice address

2020 8TH Ave Ste D
West Linn, OR 97068-4657

Phone

(503) 387-5449

Fax

(503) 342-6846

NPI assigned

Oct 24, 2017

Sex

Male

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

Enrolled in OR

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Active Edge Physical Therapy and Sports Medicine P.C.Group PAC ID 7113080714, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Active Edge Physical Therapy & Sports Medicine P.C.

  • Physical Therapy Clinic/Center
  • West Linn, OR
  • NPI 1730324336
  Medicare reassignment Care Compare group NPD
• Active Edge Physical Therapy & Sports Medicine P.C.

  • Physical Therapist
  • Beaverton, OR
  • NPI 1912574906
  NPD (past)

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

{
    "created_epoch": "1508803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1497266993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 8TH AVE STE D",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970684657",
            "telephone_number": "503-387-5449",
            "fax_number": "503-342-6846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 8TH AVE STE D",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970684657",
            "telephone_number": "503-387-5449",
            "fax_number": "503-342-6846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLENSKE",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "PT, DPT,  ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-24",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OR",
            "license": "2000038059",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "63710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Garry Cook Pow, D.C.

• Physical Therapist in West Linn, OR
• Providers in West Linn, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.