Provider Demographics
NPI:1972162667
Name:TUCKER-FISHEL, AMBER LYNNE (LPTA)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:LYNNE
Last Name:TUCKER-FISHEL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:IL
Mailing Address - Zip Code:61523-1753
Mailing Address - Country:US
Mailing Address - Phone:309-635-5804
Mailing Address - Fax:
Practice Address - Street 1:711 N 6TH ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523-1753
Practice Address - Country:US
Practice Address - Phone:309-635-5804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160000922225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant