Michael Andrew Polascik, PT ATC
Individual provider Active NPI Physical Therapist · Macon, GA
NPI 1609899558 · NPPES record last updated Sep 25, 2019
Key facts
- NPI
- 1609899558
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 3716 (GA)
- Practice address
- 3708 Northside Dr
Macon, GA 31210-2404 - Phone
- (478) 745-4206
- Fax
- (478) 254-5463
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1992
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Transperfect Health Corp
Practice addresses (Care Compare)
1170 Peachtree St NE
Suite 1600
Atlanta, GA 30309-7674
Phone (570) 854-1632
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051114000292 | GA | Practitioner - Physical Therapist in Private Practice | 1759300361 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3716 | GA | MD | Surgical Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Transperfect Health Corp | Physical Therapist | Current |
Accepting new patients |
| Sports Medicine South of Gwinnett LLC | Current |
Accepting new patients | |
| High Performance Physical Therapy Centers | Physical Therapist | Past | Accepting new patients |
| Advance Rehabilitation & Consulting Limited Partnership | Physical Therapist | Past | Accepting new patients |
| Cimarron Physical Therapy Inc | Past | Accepting new patients | |
| Therasport Physical Therapy Inc. | Past | Accepting new patients |
Locations
1170 Peachtree St NE
Ste 1600
Atlanta, GA 30309
Phone (570) 854-1632
1900 Riverside Pkwy
Lawrenceville, GA 30043
Phone (770) 237-3475
1250 Broadway
Fl 32
New York, NY 10001
Phone (212) 290-6447
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3716 | GA | Yes |
Addresses
Primary practice location
3708 Northside Dr
Macon, GA 31210-2404
Mailing address
1900 Riverside Pkwy
Lawrenceville, GA 30043-5925
Phone (770) 237-3475
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003158408A | Medicaid | GA |
Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.