Provider Demographics
NPI:1467907436
Name:TUCKEY AND ASSOCIATES PHYSICAL THERAPY SERVICES INC.
Entity Type:Organization
Organization Name:TUCKEY AND ASSOCIATES PHYSICAL THERAPY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:TUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:314-265-7616
Mailing Address - Street 1:6239 ROSEBURY AVE
Mailing Address - Street 2:2 W
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3221
Mailing Address - Country:US
Mailing Address - Phone:314-265-7616
Mailing Address - Fax:314-571-9418
Practice Address - Street 1:6239 ROSEBURY AVE
Practice Address - Street 2:2 W
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3221
Practice Address - Country:US
Practice Address - Phone:314-265-7616
Practice Address - Fax:314-571-9418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORO567225100000X
IL070.002146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty