Provider Demographics
NPI:1215229687
Name:POLLEY, MICHAEL LANG (ATP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LANG
Last Name:POLLEY
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 DC DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-0405
Mailing Address - Country:US
Mailing Address - Phone:903-597-5656
Mailing Address - Fax:903-597-5580
Practice Address - Street 1:4703 DC DR STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-597-5656
Practice Address - Fax:903-729-5496
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10296600247200000X, 225CA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other