Provider Demographics
NPI:1073128377
Name:POLLOCK, KRISTOPHER (PT)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11045 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1072
Mailing Address - Country:US
Mailing Address - Phone:877-469-3778
Mailing Address - Fax:866-721-4334
Practice Address - Street 1:3657 CORTEZ RD W STE 110
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3171
Practice Address - Country:US
Practice Address - Phone:941-739-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT36341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist