Healthcare Provider Details

I. General information

NPI: 1811181779
Provider Name (Legal Business Name): JACQUELINE POLLOCK VANMOERKERQUE P.T., DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 07/02/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6TH MEDICAL GROUP
MACDILL AFB FL
33611
US

IV. Provider business mailing address

3112 W CHAPIN AVE
TAMPA FL
33611-2702
US

V. Phone/Fax

Practice location:
  • Phone: 757-675-7782
  • Fax:
Mailing address:
  • Phone: 757-675-7782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number2305204093
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305204093
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: