Healthcare Provider Details

I. General information

NPI: 1134040645
Provider Name (Legal Business Name): POLAR PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 W CLAIREMONT DR
APPLETON WI
54913-2779
US

IV. Provider business mailing address

5700 W CLAIREMONT DR
APPLETON WI
54913-2779
US

V. Phone/Fax

Practice location:
  • Phone: 262-312-8359
  • Fax:
Mailing address:
  • Phone: 262-312-8359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOGAN GORAL
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 262-312-8359