Provider Demographics
NPI:1336202019
Name:POLKOWSKI, KATHY J (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:J
Last Name:POLKOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4932 NE TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-9792
Mailing Address - Country:US
Mailing Address - Phone:315-488-3150
Mailing Address - Fax:
Practice Address - Street 1:180 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1811
Practice Address - Country:US
Practice Address - Phone:315-255-3623
Practice Address - Fax:315-255-0852
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024426-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist