Richard Polk, PT | |
N546 Schroeter Dr, Random Lake, WI 53075-1272 | |
(920) 207-3550 | |
(920) 994-4606 |
Full Name | Richard Polk |
---|---|
Gender | Male |
Speciality | Physical Therapy |
Experience | 31 Years |
Location | N546 Schroeter Dr, Random Lake, Wisconsin |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1225233323 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 4734-024 (Wisconsin) | Primary |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Great Lakes Healthcare Inc | 5395079719 | 11 |
Provider Name | Great Lakes Healthcare Inc |
---|---|
Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1184282618 PECOS PAC ID: 5395079719 Enrollment ID: O20190730000104 |
Mailing Address | Practice Location Address |
---|---|
Richard Polk, PT N546 Schroeter Dr, Random Lake, WI 53075-1272 Ph: (920) 207-3550 | Richard Polk, PT N546 Schroeter Dr, Random Lake, WI 53075-1272 Ph: (920) 207-3550 |
Pt Connections Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 233 Carroll St, Random Lake, WI 53075 Phone: 920-994-4515 Fax: 920-994-4583 | |
Mrs. Marlena Elizabeth Salazar, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: N546 Schroeter Dr, Random Lake, WI 53075 Phone: 920-207-3550 Fax: 920-994-8466 | |
Abby Lynn Risse, PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 402 1st St, Random Lake, WI 53075 Phone: 920-994-9700 Fax: 920-994-4606 | |
Mrs. Julie M. Schmitt, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: N546 Schroeter Dr, Random Lake, WI 53075 Phone: 920-994-9700 | |
Michelle M Grace-jensen, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 233 Carroll St, Random Lake, WI 53075 Phone: 920-912-0058 | |
Ms. Virginia K Bowen, P.T. Physical Therapist Medicare: Medicare Enrolled Practice Location: 402 First Street, Random Lake, WI 53075 Phone: 920-994-9700 Fax: 920-994-4606 |