Individual
DENISE MICHELLE POLNISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
100 N EAGLE CREEK DR, LEXINGTON, KY 40509-1805
(859) 258-5073
(859) 258-5074
Mailing address
100 N EAGLE CREEK DR, LEXINGTON, KY 40509-1805
(859) 258-5073
(859) 258-5074
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-004403
KY
2251S0007X
Sports Physical Therapist
PT-004403
KY
2251X0800X
Orthopedic Physical Therapist
PT-004403
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
01
—
CB5773
RR MEDICARE GROUP
KY
Enumeration date
11/14/2006
Last updated
11/02/2007
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