MEDICARE: JACOB POLLARD DPT

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

General Provider Information

NPI Number	:	1386191781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB POLLARD DPT

Provider Business Mailing Address
First Line	:	3190 E MERIDIAN PARK LOOP STE 206
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7422
Country	:	US
Telephone Number	:	907-373-9462
Fax Number	:

Provider Business Practice Location Address
First Line	:	3190 E MERIDIAN PARK LOOP STE 206
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7422
Country	:	US
Telephone Number	:	907-373-9462
Fax Number	:

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

Provider Enumeration Date	:	09/02/2016
Last Update Date	:	10/25/2021

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Directions to “ JACOB POLLARD DPT” Practice Location

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