Tracey Polk, PT

Primary specialty

Geriatric Physical TherapistTaxonomy code 2251G0304X

License

25698 Issued in MD

Practice address

14235 Park Center Dr
Laurel, MD 20707-5261

Phone

(301) 498-8100

Fax

(301) 498-0009

NPI assigned

Apr 25, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Tracey St Hill Blake Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1265607642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 500",
            "city": "BROOKEVILLE",
            "state": "MD",
            "postal_code": "208330500",
            "telephone_number": "301-498-8100",
            "fax_number": "301-498-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14235 PARK CENTER DR",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207075261",
            "telephone_number": "301-498-8100",
            "fax_number": "301-498-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLK",
        "first_name": "TRACEY",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-25",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "NC",
            "license": "6033",
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "MD",
            "license": "25698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEY",
            "last_name": "ST HILL BLAKE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Geriatric Physical Therapist in Laurel, MD
• Providers in Laurel, MD by specialty
• Geriatric Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.