Provider Demographics
NPI:1710020037
Name:POLLY, JON E (PT)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:E
Last Name:POLLY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16219 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6910
Mailing Address - Country:US
Mailing Address - Phone:818-831-2400
Mailing Address - Fax:818-831-2411
Practice Address - Street 1:16223 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6910
Practice Address - Country:US
Practice Address - Phone:818-831-2400
Practice Address - Fax:818-831-2411
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist