Provider Demographics
NPI:1457738783
Name:TUCKER, BOBBY LEE II (LMT)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:LEE
Last Name:TUCKER
Suffix:II
Gender:M
Credentials:LMT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:150 WEST MAIN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054
Mailing Address - Country:US
Mailing Address - Phone:614-332-0262
Mailing Address - Fax:
Practice Address - Street 1:150 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9229
Practice Address - Country:US
Practice Address - Phone:614-685-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.013657-T-Z225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist