Provider Demographics
NPI:1659192771
Name:PAFFORD, POLLY PATRICIA (PTA)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:PATRICIA
Last Name:PAFFORD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:POLLY
Other - Middle Name:PATRICIA
Other - Last Name:HOEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:17190 PLOW CAMP RD
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-9552
Mailing Address - Country:US
Mailing Address - Phone:209-587-0615
Mailing Address - Fax:
Practice Address - Street 1:285 MERCEY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3878
Practice Address - Country:US
Practice Address - Phone:209-829-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4011225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant