MEDICARE: SHANE POLATIS PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251S0007X	Sports Physical Therapist	2983	NV
2	2251X0800X	Orthopedic Physical Therapist	2983	NV
3	225100000X	Physical Therapist	2983	NV

General Provider Information

NPI Number	:	1871909630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE POLATIS PT, DPT

Provider Business Mailing Address
First Line	:	9550 S EASTERN AVE STE 253
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-8042
Country	:	US
Telephone Number	:	702-818-1770
Fax Number	:

Provider Business Practice Location Address
First Line	:	4794 S EASTERN AVE STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6145
Country	:	US
Telephone Number	:	702-818-1770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	09/21/2024

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Directions to “ SHANE POLATIS PT, DPT” Practice Location

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