Provider Demographics
NPI:1881700052
Name:POLLOCK, LINDA KAYE (BSPT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:KAYE
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:K
Other - Last Name:SHEPPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSPT
Mailing Address - Street 1:2740 LAKE OTIS PKWY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4143
Mailing Address - Country:US
Mailing Address - Phone:907-743-3310
Mailing Address - Fax:907-272-8164
Practice Address - Street 1:2740 LAKE OTIS PKWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4143
Practice Address - Country:US
Practice Address - Phone:907-743-3310
Practice Address - Fax:907-272-8164
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPHYP414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1029744Medicaid
AKPT4640Medicaid