Kim A. Polasek, P.T.
Individual provider Active NPI Physical Therapist · Taft, TX
NPI 1871570119 · NPPES record last updated Nov 30, 2011
Key facts
- NPI
- 1871570119
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1036226 (TX)
- Practice address
- 202 Green Ave
Taft, TX 78390-2706 - Phone
- (361) 528-3018
- Fax
- (361) 528-3542
- NPI assigned
- Dec 28, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1036226 | TX | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1036226 | TX | Yes |
Addresses
Primary practice location
202 Green Ave
Taft, TX 78390-2706
Mailing address
202 Green Ave
Taft, TX 78390-2706
Phone (361) 528-3018
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0876815-01 | Medicaid | TX |
Other providers in Taft, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.