Individual
GINA RENAE POLANSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
370 E HERSEY ST STE 1, ASHLAND, OR 97520-2325
(541) 482-6360
Mailing address
504 KEENE DR, MEDFORD, OR 97504-8027
(970) 219-2459
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60382
STATE OF OREGON PHYSICAL THERAPY LICENSING BOARD
OR
01
—
8666
LICENSE #
CO
Enumeration date
08/24/2006
Last updated
08/08/2014
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