Provider Demographics
NPI:1093252900
Name:TUCKER, PAMELA O (PT DPT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:O
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:729 THIMBLE SHOALS BLVD STE
Mailing Address - Street 2:STE 4-C
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606
Mailing Address - Country:US
Mailing Address - Phone:757-873-2932
Mailing Address - Fax:757-873-8780
Practice Address - Street 1:304 MARCELLA RD
Practice Address - Street 2:STE E
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-825-9446
Practice Address - Fax:757-825-9476
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305204128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist