MEDICARE: JOSIAH D. POLITO 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	004743	IA

General Provider Information

NPI Number	:	1982992848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSIAH D. POLITO DPT

Provider Business Mailing Address
First Line	:	1129 11TH ST SE
Second Line	:	SUITE A
City	:	DYERSVILLE
State	:	IA
Zip	:	52040-2050
Country	:	US
Telephone Number	:	563-875-8615
Fax Number	:	563-875-8722

Provider Business Practice Location Address
First Line	:	1210 WEST MAIN ST.
Second Line	:
City	:	MANCHESTER
State	:	IA
Zip	:	52057-2305
Country	:	US
Telephone Number	:	563-927-1499
Fax Number	:	563-927-1489

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

Provider Enumeration Date	:	07/13/2011
Last Update Date	:	11/15/2016

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