Provider Demographics
NPI:1265079487
Name:POLAR PHYSICAL THERAPY AND FITNESS P.L.L.C
Entity type:Organization
Organization Name:POLAR PHYSICAL THERAPY AND FITNESS P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:PLICHOTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, CPT
Authorized Official - Phone:586-596-8258
Mailing Address - Street 1:36292 FARMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1508
Mailing Address - Country:US
Mailing Address - Phone:586-596-8258
Mailing Address - Fax:
Practice Address - Street 1:36292 FARMBROOK DR
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-1508
Practice Address - Country:US
Practice Address - Phone:586-596-8258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501017229OtherLICENSE ID