Provider Demographics
NPI:1619984002
Name:TUCKER, KAREN SUE (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 NW DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2605
Mailing Address - Country:US
Mailing Address - Phone:817-447-1569
Mailing Address - Fax:407-200-8742
Practice Address - Street 1:602 COURTLAND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1360
Practice Address - Country:US
Practice Address - Phone:407-975-3000
Practice Address - Fax:407-200-8742
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX147801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist