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General NPI Number Information
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NPI Number | 1134258924
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Entity Type | Individual
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Provider Name | BRIDGET POLLEY PT
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | E8811 COUNTY ROAD HH
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City | NEW LONDON
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State | WI
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Zip | 54961-8763
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Country | US
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Telephone | 920-538-1548
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Fax |
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Provider Business Mailing Address
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Address Line | E8811 COUNTY ROAD HH
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City | NEW LONDON
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State | WI
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Zip | 54961-8763
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Country | US
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Telephone | 920-538-1548
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 674-019
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11883-24
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License Number State | WI
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