Provider Demographics
NPI:1689967325
Name:TUCKER, DEBBIE
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8804 STATE ROUTE 945
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:KY
Mailing Address - Zip Code:42027-8610
Mailing Address - Country:US
Mailing Address - Phone:270-856-3881
Mailing Address - Fax:
Practice Address - Street 1:2855 JACKSON ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7602
Practice Address - Country:US
Practice Address - Phone:270-415-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02720225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant