Provider Demographics
NPI:1366646374
Name:POLLEY, FRED (LMT)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:POLLEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 W WOOLBRIGHT RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6332
Mailing Address - Country:US
Mailing Address - Phone:561-735-3394
Mailing Address - Fax:561-735-3394
Practice Address - Street 1:2240 W WOOLBRIGHT RD
Practice Address - Street 2:SUITE 406
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6332
Practice Address - Country:US
Practice Address - Phone:561-735-3394
Practice Address - Fax:561-735-3394
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM11447225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist