Provider Demographics
NPI:1306459581
Name:POLLARD, STORMIE G (LMT)
Entity type:Individual
Prefix:MRS
First Name:STORMIE
Middle Name:G
Last Name:POLLARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 MONDAY ST
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-9790
Mailing Address - Country:US
Mailing Address - Phone:561-231-4701
Mailing Address - Fax:
Practice Address - Street 1:1125 MONDAY ST
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-9790
Practice Address - Country:US
Practice Address - Phone:561-231-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA91804225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist