Provider Demographics
NPI:1124049689
Name:BADT, POLLY A (PT)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:A
Last Name:BADT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LATIMER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-1011
Mailing Address - Country:US
Mailing Address - Phone:310-456-8301
Mailing Address - Fax:310-317-1553
Practice Address - Street 1:9 LATIMER RD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-1011
Practice Address - Country:US
Practice Address - Phone:310-456-8301
Practice Address - Fax:310-317-1553
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT15196Medicare PIN