Provider Demographics
NPI:1275707176
Name:TUCKER, DAVID LAWRENCE JR (RPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:TUCKER
Suffix:JR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:671 W ESPLANADE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2794
Mailing Address - Country:US
Mailing Address - Phone:504-467-5900
Mailing Address - Fax:504-467-7272
Practice Address - Street 1:4921 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5664
Practice Address - Country:US
Practice Address - Phone:504-889-2663
Practice Address - Fax:504-889-5615
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist