Provider Demographics
NPI:1720802333
Name:POLAND, FAITH ELAINE
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:ELAINE
Last Name:POLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67831-3199
Mailing Address - Country:US
Mailing Address - Phone:620-635-3119
Mailing Address - Fax:620-635-3180
Practice Address - Street 1:625 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KS
Practice Address - Zip Code:67831-3199
Practice Address - Country:US
Practice Address - Phone:620-635-3119
Practice Address - Fax:620-635-3180
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-06224225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant