Provider Demographics
NPI:1801008800
Name:POLEK, WILLIAM JOHN (MPT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOHN
Last Name:POLEK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 PARKVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7157
Mailing Address - Country:US
Mailing Address - Phone:215-917-4170
Mailing Address - Fax:
Practice Address - Street 1:700 N COLORADO BOULEVARD #318
Practice Address - Street 2:
Practice Address - City:DEBVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4036
Practice Address - Country:US
Practice Address - Phone:866-801-9492
Practice Address - Fax:866-293-4719
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1158090225100000X
PAPT-013704-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist