Provider Demographics
NPI:1679522544
Name:POLK THERAPY
Entity Type:Organization
Organization Name:POLK THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-287-6081
Mailing Address - Street 1:346 E CENTRAL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3046
Mailing Address - Country:US
Mailing Address - Phone:863-291-8644
Mailing Address - Fax:
Practice Address - Street 1:346 E CENTRAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3046
Practice Address - Country:US
Practice Address - Phone:863-291-8644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty