Provider Demographics
NPI:1356655799
Name:TUCKER, LYNN AILEEN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:AILEEN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-5301
Mailing Address - Country:US
Mailing Address - Phone:406-656-3366
Mailing Address - Fax:
Practice Address - Street 1:1407 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-5301
Practice Address - Country:US
Practice Address - Phone:406-656-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT164225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist