Provider Demographics
NPI:1265607642
Name:POLK, TRACEY (PT)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:POLK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:ST HILL BLAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-0500
Mailing Address - Country:US
Mailing Address - Phone:301-498-8100
Mailing Address - Fax:301-498-0009
Practice Address - Street 1:14235 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5261
Practice Address - Country:US
Practice Address - Phone:301-498-8100
Practice Address - Fax:301-498-0009
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60332251G0304X
MD256982251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics