Active NPI
Jonathan Polanco Soto
- Physical Therapist
- Fitchburg, MA
National Provider Identifier
1568387413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 450 John Fitch Hwy FL 1
Fitchburg, MA 01420-8400 - Phone
- (978) 346-5311
- Fax
- (978) 910-0462
- NPI assigned
- Aug 11, 2026
- Last updated
- Aug 11, 2026
- Sex
- Male
- Sole proprietor
- Yes
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 | NU | Primary |
Addresses
Primary practice location
450 John Fitch Hwy FL 1
Fitchburg, MA 01420-8400
Mailing address
576 Broadhollow Rd
Melville, NY 11747-5012
Phone (631) 359-5859
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1786406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786406400000",
"number": "1568387413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "576 BROADHOLLOW RD",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117475012",
"telephone_number": "631-359-5859",
"fax_number": "631-396-0864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 JOHN FITCH HWY FL 1",
"city": "FITCHBURG",
"state": "MA",
"postal_code": "014208400",
"telephone_number": "978-346-5311",
"fax_number": "978-910-0462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLANCO SOTO",
"first_name": "JONATHAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-08-11",
"last_updated": "2026-08-11",
"certification_date": "2026-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fitchburg, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.