Provider Demographics
NPI:1447652094
Name:WOLGAT POLANCO, LOUISE (DPT)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:WOLGAT POLANCO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:
Other - Last Name:WOLGAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5100 ELDORADO PKWY
Mailing Address - Street 2:#102-20SWSS
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6510
Mailing Address - Country:US
Mailing Address - Phone:214-265-7200
Mailing Address - Fax:214-265-7521
Practice Address - Street 1:11661 PRESTON RD
Practice Address - Street 2:173
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2745
Practice Address - Country:US
Practice Address - Phone:214-265-7200
Practice Address - Fax:214-265-7521
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1249266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1249266OtherPT LICENSE