Basic Information
| Provider Information | |||||||||
| NPI: | 1356822704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLLARD | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1444 FALLS AVE E STE 401 | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833013408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087362574 | ||||||||
| FaxNumber: | 2087362594 | ||||||||
| Practice Location | |||||||||
| Address1: | 243 CHENEY DR W | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833014277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083297667 | ||||||||
| FaxNumber: | 2083297669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2018 | ||||||||
| LastUpdateDate: | 04/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3854 | NV | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT-6982 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3854 | 01 | NV | STATE OF NEVADA BOARD OF PHYSICAL THERAPY | OTHER |