Provider Demographics
NPI:1851595946
Name:TUCKER, MEREDITH (MSPT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 240TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-1674
Mailing Address - Country:US
Mailing Address - Phone:913-406-8040
Mailing Address - Fax:
Practice Address - Street 1:961 240TH ST
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-1674
Practice Address - Country:US
Practice Address - Phone:913-406-8040
Practice Address - Fax:515-864-0150
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist