Provider Demographics
NPI:1194297374
Name:POLLOCK, MARIE DREHER (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:DREHER
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ALYSSA
Other - Last Name:DREHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1721 E 19TH AVE STE 468
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1242
Mailing Address - Country:US
Mailing Address - Phone:303-830-0018
Mailing Address - Fax:
Practice Address - Street 1:1721 E 19TH AVE STE 468
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1242
Practice Address - Country:US
Practice Address - Phone:303-830-0018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist