Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 12404-24 | WI |
NPI | 1003237553 |
---|---|
Provider Name | Sarah Polenska |
First Address | Madison, WI 53703-3018 |
Second Address | Madison, WI 53703-3018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2013 |
Last Update Date | 31/12/2013 |