Provider Demographics
NPI:1134662364
Name:POLLLARD, BRADIE SARAH (MS, LAT, ATC,CSCS)
Entity Type:Individual
Prefix:
First Name:BRADIE
Middle Name:SARAH
Last Name:POLLLARD
Suffix:
Gender:F
Credentials:MS, LAT, ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-1501
Mailing Address - Country:US
Mailing Address - Phone:973-713-6495
Mailing Address - Fax:
Practice Address - Street 1:85 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885
Practice Address - Country:US
Practice Address - Phone:973-713-6495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-20
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.56892255A2300X
390200000X
PART0079132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program