Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-004403 | KY |
N | 2251S0007X | Physical Therapist - Sports | PT-004403 | KY |
N | 2251X0800X | Physical Therapist - Orthopedic | PT-004403 | KY |
NPI | 1043382294 |
---|---|
Provider Name | Denise Michelle Polnisch |
First Address | Lexington, KY 40509-1805 |
Second Address | Lexington, KY 40509-1805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 02/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
37903705 | MEDICAID LAB GROUP (01) | KY |
4000501 | MEDICARE LAB GROUP (01) | KY |
CB5773 | RR MEDICARE GROUP (01) | KY |