Provider Demographics
NPI:1790867331
Name:TUCKER, MONA FAYE (PT)
Entity Type:Individual
Prefix:MISS
First Name:MONA
Middle Name:FAYE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:966 N GARDEN RIDGE BLVD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2827
Mailing Address - Country:US
Mailing Address - Phone:972-420-6605
Mailing Address - Fax:972-436-2770
Practice Address - Street 1:3330 MATLOCK RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2917
Practice Address - Country:US
Practice Address - Phone:817-472-8383
Practice Address - Fax:817-472-8386
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist