Provider Demographics
NPI:1114323896
Name:POLLARD GROS, DEBRACA (PT)
Entity Type:Individual
Prefix:
First Name:DEBRACA
Middle Name:
Last Name:POLLARD GROS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16558 LONG LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4295
Mailing Address - Country:US
Mailing Address - Phone:225-921-4321
Mailing Address - Fax:
Practice Address - Street 1:3676 HARDING BLVD
Practice Address - Street 2:B&C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-5258
Practice Address - Country:US
Practice Address - Phone:225-810-3518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist