Provider Demographics
NPI:1407309289
Name:POLLARD, KACIE (PT)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:POLLARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PLEASANT PLACE CT
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1187
Mailing Address - Country:US
Mailing Address - Phone:843-252-1810
Mailing Address - Fax:843-521-0908
Practice Address - Street 1:6 PLEASANT PLACE CT
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1187
Practice Address - Country:US
Practice Address - Phone:843-252-1810
Practice Address - Fax:843-521-0908
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8282OtherLICENSE