Provider Demographics
NPI:1366057390
Name:POLLEY, THOMAS JAMES
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:POLLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 TESLA AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5821
Mailing Address - Country:US
Mailing Address - Phone:831-760-9032
Mailing Address - Fax:
Practice Address - Street 1:13380 CUESTA VERDE
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93908-9313
Practice Address - Country:US
Practice Address - Phone:831-760-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46849225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist