Provider Demographics
NPI:1306086574
Name:SUNRISE PEDIATRIC THERAPY, P.C.
Entity type:Organization
Organization Name:SUNRISE PEDIATRIC THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:POLUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L
Authorized Official - Phone:610-217-1280
Mailing Address - Street 1:971K VILLAGE ROUND
Mailing Address - Street 2:
Mailing Address - City:WESCOSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9786
Mailing Address - Country:US
Mailing Address - Phone:610-217-1280
Mailing Address - Fax:
Practice Address - Street 1:971K VILLAGE ROUND
Practice Address - Street 2:
Practice Address - City:WESCOSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18106-9786
Practice Address - Country:US
Practice Address - Phone:610-217-1280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005091L252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency