MEDICARE: DR. SHELLY POLNICK LEICESTER 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	225100000X	Physical Therapist	1134518	TX
2	2251X0800X	Orthopedic Physical Therapist	1134518	TX

General Provider Information

NPI Number	:	1952489882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLY POLNICK LEICESTER PT, DPT

Provider Business Mailing Address
First Line	:	5757 WARREN PKWY
Second Line	:	SUITE 180
City	:	FRISCO
State	:	TX
Zip	:	75034-4274
Country	:	US
Telephone Number	:	214-618-4301
Fax Number	:	214-618-4302

Provider Business Practice Location Address
First Line	:	5757 WARREN PKWY
Second Line	:	SUITE 180
City	:	FRISCO
State	:	TX
Zip	:	75034-4274
Country	:	US
Telephone Number	:	214-618-4301
Fax Number	:	214-618-4302

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/03/2013

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