Provider Demographics
NPI:1679982391
Name:TUCKER, CAROLINE KIRKLAND RUFFIN (DPT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:KIRKLAND RUFFIN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 VIRGINIA BEACH BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5631
Mailing Address - Country:US
Mailing Address - Phone:757-455-5000
Mailing Address - Fax:757-319-4142
Practice Address - Street 1:1120 FIRST COLONIAL RD STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-455-5000
Practice Address - Fax:757-319-4142
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist