Provider Demographics
NPI:1710378542
Name:POLLARD, ELISA (DPT)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:POLLARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4341 PIEDMONT AVENUE, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4767
Mailing Address - Country:US
Mailing Address - Phone:510-547-1630
Mailing Address - Fax:510-923-1944
Practice Address - Street 1:4341 PIEDMONT AVENUE, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4767
Practice Address - Country:US
Practice Address - Phone:510-547-1630
Practice Address - Fax:510-923-1944
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist