Provider Demographics
NPI:1033894266
Name:GAMBLE, TUCKER (DPT)
Entity Type:Individual
Prefix:
First Name:TUCKER
Middle Name:
Last Name:GAMBLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-3104
Mailing Address - Country:US
Mailing Address - Phone:801-633-8151
Mailing Address - Fax:
Practice Address - Street 1:1163 E 1220 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-5433
Practice Address - Country:US
Practice Address - Phone:801-633-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13398777-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist