Provider Demographics
NPI:1205322195
Name:TUCKER, SILAS (DPT)
Entity type:Individual
Prefix:
First Name:SILAS
Middle Name:
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 BRYLINGTON LOOP
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-8430
Mailing Address - Country:US
Mailing Address - Phone:251-363-6853
Mailing Address - Fax:
Practice Address - Street 1:7830 PINE FOREST RD # COTTAGEA
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-8404
Practice Address - Country:US
Practice Address - Phone:507-416-7158
Practice Address - Fax:850-204-0489
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist