Provider Demographics
NPI:1043233778
Name:POLK THERAPY LLC
Entity Type:Organization
Organization Name:POLK THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-291-8644
Mailing Address - Street 1:295 1ST ST S
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3272
Mailing Address - Country:US
Mailing Address - Phone:863-291-8644
Mailing Address - Fax:863-293-3221
Practice Address - Street 1:295 1ST ST S
Practice Address - Street 2:SUITE 2
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3272
Practice Address - Country:US
Practice Address - Phone:863-291-8644
Practice Address - Fax:863-293-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL68-4852261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
68-4852Medicare ID - Type UnspecifiedMEDICARE