Provider Demographics
NPI:1760640072
Name:TUCKER, JOSEPH M (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:TUCKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 HIGHWAY 31 SW
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-2857
Mailing Address - Country:US
Mailing Address - Phone:256-502-8684
Mailing Address - Fax:256-502-8923
Practice Address - Street 1:913 HIGHWAY 31 SW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2857
Practice Address - Country:US
Practice Address - Phone:256-502-8684
Practice Address - Fax:256-502-8923
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1811437163OtherGROUP NPI
AL014536OtherGROUP MEDICARE PART A
ALK531OtherGROUP MEDICARE
AL529917620OtherGROUP MEDICAID