Provider Demographics
NPI:1053701516
Name:POLLASTRO, BRITTANY (MA, ATC)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:POLLASTRO
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 S HIDDEN VALLEY DR UNIT 211
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6930
Mailing Address - Country:US
Mailing Address - Phone:435-650-6052
Mailing Address - Fax:
Practice Address - Street 1:225 S 700 E
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3875
Practice Address - Country:US
Practice Address - Phone:435-650-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT875193148102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer