Provider Demographics
NPI:1356822704
Name:POLLARD, BRANDON J (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:J
Last Name:POLLARD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 FALLS AVE E STE 401
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3408
Mailing Address - Country:US
Mailing Address - Phone:208-736-2574
Mailing Address - Fax:208-736-2594
Practice Address - Street 1:243 CHENEY DR W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4277
Practice Address - Country:US
Practice Address - Phone:208-329-7667
Practice Address - Fax:208-329-7669
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3854225100000X
IDPT-6982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3854OtherSTATE OF NEVADA BOARD OF PHYSICAL THERAPY