Provider Demographics
NPI:1710962899
Name:TUCKER, ALANA CHRISTINE (PT)
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:CHRISTINE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALANA
Other - Middle Name:CHRISTINE
Other - Last Name:FOOTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:25285 MADISON AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8955
Mailing Address - Country:US
Mailing Address - Phone:951-600-2990
Mailing Address - Fax:951-600-7224
Practice Address - Street 1:25285 MADISON AVE
Practice Address - Street 2:STE 104
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8955
Practice Address - Country:US
Practice Address - Phone:951-600-2990
Practice Address - Fax:951-600-7224
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT256050Medicare ID - Type Unspecified