Individual
LORRAINE POLCHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4718 N ELIZABETH ST STE A, PUEBLO, CO 81008-2080
(719) 544-5895
Mailing address
4718 N ELIZABETH ST STE A, PUEBLO, CO 81008-2080
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA0012060
CO
Other
Enumeration date
06/30/2016
Last updated
06/30/2016
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