Provider Demographics
NPI:1346472560
Name:POLLARD, KEMBA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KEMBA
Middle Name:
Last Name:POLLARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PAERDEGAT 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4107
Mailing Address - Country:US
Mailing Address - Phone:718-288-6557
Mailing Address - Fax:
Practice Address - Street 1:29 PAERDEGAT 8TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4107
Practice Address - Country:US
Practice Address - Phone:718-288-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist