Provider Demographics
NPI:1386863827
Name:TUCKER, GRACE M (PT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:M
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:C
Other - Last Name:MAGHOPOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:554 GREEN BAY RD STE B
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:IL
Practice Address - Zip Code:60043-1086
Practice Address - Country:US
Practice Address - Phone:847-256-3500
Practice Address - Fax:847-256-3513
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist