Basic Information
| Provider Information | |||||||||
| NPI: | 1770619603 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POLLOCK | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC,OTC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 MARY BATCHELDER RD | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038421701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039269629 | ||||||||
| FaxNumber: | 6034313347 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 ROUTE ONE BYPASS | ||||||||
| Address2: | SPORTSMEDICINE ATLANTIC ORTHOPAEDICS | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034311121 | ||||||||
| FaxNumber: | 6034313347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 0102 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.