Provider Demographics
NPI:1396990594
Name:POLLOCK, MELODY (PT)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:POLLOCK
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 1:20 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-1257
Mailing Address - Country:US
Mailing Address - Phone:814-362-7466
Mailing Address - Fax:814-362-9803
Practice Address - Street 1:20 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1257
Practice Address - Country:US
Practice Address - Phone:814-362-7466
Practice Address - Fax:814-362-9803
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000155E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist