Provider Demographics
NPI:1831921675
Name:POLLOCK, SIERRA E (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:SIERRA
Middle Name:E
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:E
Other - Last Name:ILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6000 SPRINGS WAY APT 6212
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-0060
Mailing Address - Country:US
Mailing Address - Phone:651-470-5432
Mailing Address - Fax:
Practice Address - Street 1:6000 SPRINGS WAY APT 6212
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-0060
Practice Address - Country:US
Practice Address - Phone:651-470-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist