Provider Demographics
NPI:1386613263
Name:POLLOCK PHYSICAL THERAPY
Entity type:Organization
Organization Name:POLLOCK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:909-946-7658
Mailing Address - Street 1:1238 E ARROW HWY
Mailing Address - Street 2:FLOOR #2
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4951
Mailing Address - Country:US
Mailing Address - Phone:909-946-7658
Mailing Address - Fax:909-931-7838
Practice Address - Street 1:1238 E ARROW HWY
Practice Address - Street 2:FLOOR #2
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4951
Practice Address - Country:US
Practice Address - Phone:909-946-7658
Practice Address - Fax:909-931-7838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23575174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA592CAOtherPTPN MEMBER
CAZZZ29998ZMedicare ID - Type Unspecified