Jaclyn Ann Polk, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P18923 Issued in NC

Practice address

5011 Weddington Rd Ste 50
Concord, NC 28027-9037

Phone

(980) 248-1211

NPI assigned

Mar 9, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Jaclyn Ann Reifschneider Former name

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

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.

• Professional Sportscare & Rehab, LLC

  dba Pivot Physical Therapy of Metro DC

  • Clinic/Center
  • Winchester, VA
  • NPI 1033142294

  DC

  Medicare reassignment
• Stewart Physical Therapy Clinic Inc

  • Specialist
  • Mebane, NC
  • NPI 1982710562
  NPD (past)
• Professional Sportscare & Rehab, LLC

  dba Pivot Physical Therapy

  • Physical Therapist
  • Woodbridge, VA
  • NPI 1548714959
  NPD (past)

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

{
    "created_epoch": "1331251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565049600000",
    "number": "1679848667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5011 WEDDINGTON RD STE 50",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280279037",
            "telephone_number": "980-248-1211",
            "fax_number": "703-471-0247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5011 WEDDINGTON RD STE 50",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280279037",
            "telephone_number": "980-248-1211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "516 Herndon Pkwy",
            "address_purpose": "LOCATION",
            "city": "Herndon",
            "state": "VA",
            "postal_code": "201706230",
            "country_code": "US",
            "telephone_number": "703-478-0190",
            "fax_number": "703-471-0247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLK",
        "first_name": "JACLYN",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-09",
        "last_updated": "2019-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305207809",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "DC",
            "license": "PT871313",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P18923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY",
            "identifier": "1679848667",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "REIFSCHNEIDER",
            "middle_name": "ANN",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Wallace H Plyler Jr.
• Montana Marshall Poe, FNP
• Robert Patrick Poetta, MD
• Jerry John Pokorney, D.C.
• Latrice Avery Polite, FNP-C
• Michelle Renee Polk
• Ronald Anthony Pollack, MD
• Shandis Ponds
• Danielle Ponsoll
• Sandra K Pontius, RN,ANP-C

• Physical Therapist in Concord, NC
• Providers in Concord, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.