MEDICARE: KATHLEEN E POLLAN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225100000X	Physical Therapist	1240738	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1240738	OTHER	TX	PT LICENSE

General Provider Information

NPI Number	:	1194149856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN E POLLAN PT

Provider Business Mailing Address
First Line	:	6501 HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-6102
Country	:	US
Telephone Number	:	817-370-9891
Fax Number	:	817-370-9894

Provider Business Practice Location Address
First Line	:	7630 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1299
Country	:	US
Telephone Number	:	817-428-9900
Fax Number	:	817-370-9894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2014
Last Update Date	:	03/10/2021

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Directions to “ KATHLEEN E POLLAN PT” Practice Location

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