Provider Demographics
NPI:1801191705
Name:GIFFORD, POLLY ANN
Entity Type:Individual
Prefix:MRS
First Name:POLLY
Middle Name:ANN
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 CALGARY DR
Mailing Address - Street 2:3715 CALGARY DRIVE
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-6015
Mailing Address - Country:US
Mailing Address - Phone:775-851-3792
Mailing Address - Fax:
Practice Address - Street 1:3715 CALGARY DR
Practice Address - Street 2:3715 CALGARY DRIVE
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-6015
Practice Address - Country:US
Practice Address - Phone:775-851-3792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner