Individual
KACEY D POLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
910 N DATE ST, TRUTH OR CONSEQUENCES, NM 87901-1748
(575) 894-1828
(575) 894-6873
Mailing address
910 N DATE ST, TRUTH OR CONSEQUENCES, NM 87901-1748
(575) 894-1828
(575) 894-6873
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3167
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39531864
—
NM
Enumeration date
08/24/2006
Last updated
02/23/2016
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