Healthcare Provider Details

I. General information

NPI: 1891264149
Provider Name (Legal Business Name): KRISTEN MARY POLASKI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 CLEAR LAKE CITY BLVD
WEBSTER TX
77598-6606
US

IV. Provider business mailing address

1 HERMANN MUSEUM CIRCLE DR APT 4020
HOUSTON TX
77004-7385
US

V. Phone/Fax

Practice location:
  • Phone: 281-282-1900
  • Fax: 281-282-1990
Mailing address:
  • Phone: 610-306-9687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1304068
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: