Provider Demographics
NPI:1134897697
Name:POLLASTRELLI, MICHAEL S (PTA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:POLLASTRELLI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 NEW RD STE C
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1060
Mailing Address - Country:US
Mailing Address - Phone:609-601-6150
Mailing Address - Fax:609-601-6141
Practice Address - Street 1:1999 NEW RD STE C
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1060
Practice Address - Country:US
Practice Address - Phone:609-601-6150
Practice Address - Fax:609-601-6141
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00386300225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant