Provider Demographics
NPI:1194149856
Name:POLLAN, KATHLEEN E (PT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:POLLAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:E
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6501 HARRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-6102
Mailing Address - Country:US
Mailing Address - Phone:817-370-9891
Mailing Address - Fax:817-370-9894
Practice Address - Street 1:7630 N BEACH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1299
Practice Address - Country:US
Practice Address - Phone:817-428-9900
Practice Address - Fax:817-370-9894
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX1240738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1240738OtherPT LICENSE