Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 213531 | TX |
Y | 225100000X | Physical Therapist | 1309289 | TX |
NPI | 1003286972 |
---|---|
Provider Name | Chaddrick Polk |
First Address | Prosper, TX 75078-9152 |
Second Address | Prosper, TX 75078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2015 |
Last Update Date | 08/08/2018 |