Provider Demographics
NPI:1851060214
Name:TUKOVINIT, VALALUCK (LMT)
Entity Type:Individual
Prefix:
First Name:VALALUCK
Middle Name:
Last Name:TUKOVINIT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 ELMHURST AVE APT C7
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1510
Mailing Address - Country:US
Mailing Address - Phone:646-932-8462
Mailing Address - Fax:
Practice Address - Street 1:8811 ELMHURST AVE APT C7
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1510
Practice Address - Country:US
Practice Address - Phone:646-932-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021418-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist