Healthcare Provider Details

I. General information

NPI: 1952796336
Provider Name (Legal Business Name): MRS. KRISTEN JOAN POLLACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 PENLLYN PIKE
SPRING HOUSE PA
19477-1111
US

IV. Provider business mailing address

386 CHADWYCK CIR
HARLEYSVILLE PA
19438-2373
US

V. Phone/Fax

Practice location:
  • Phone: 215-646-1500
  • Fax:
Mailing address:
  • Phone: 215-407-8687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI001836
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: