Individual
THEODORE WILLIAM POLAKOWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2909 E FOX ST, MESA, AZ 85213-5443
(480) 641-1798
Mailing address
2909 E FOX ST, MESA, AZ 85213-5443
(480) 641-1798
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/09/2017
Last updated
10/09/2017
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