Provider Demographics
NPI:1982992848
Name:POLITO, JOSIAH D (DPT)
Entity type:Individual
Prefix:
First Name:JOSIAH
Middle Name:D
Last Name:POLITO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 11TH ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DYERSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52040-2050
Mailing Address - Country:US
Mailing Address - Phone:563-875-8615
Mailing Address - Fax:563-875-8722
Practice Address - Street 1:1210 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-2305
Practice Address - Country:US
Practice Address - Phone:563-927-1499
Practice Address - Fax:563-927-1489
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist