Provider Demographics
NPI:1114781317
Name:POLONUS, DAVID JOHN II (DPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:POLONUS
Suffix:II
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-1750
Mailing Address - Country:US
Mailing Address - Phone:330-534-8500
Mailing Address - Fax:330-534-3926
Practice Address - Street 1:1404 N CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:MINERAL RIDGE
Practice Address - State:OH
Practice Address - Zip Code:44440-9615
Practice Address - Country:US
Practice Address - Phone:330-349-0303
Practice Address - Fax:330-349-0404
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist