Provider Demographics
NPI:1477921120
Name:TUCKER, JOSHUA (DPT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JOSH
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3451 TECHNOLOGICAL AVE
Mailing Address - Street 2:STE 15
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-8353
Mailing Address - Country:US
Mailing Address - Phone:407-643-2806
Mailing Address - Fax:407-643-2806
Practice Address - Street 1:2572 W STATE ROAD 426 STE 1080
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8300
Practice Address - Country:US
Practice Address - Phone:407-796-5265
Practice Address - Fax:407-796-5260
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT305702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic