Provider Demographics
NPI:1700986700
Name:TUCKER, LUANN (PT)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 FLEISCHMANN WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4155
Mailing Address - Country:US
Mailing Address - Phone:775-885-7827
Mailing Address - Fax:775-885-2301
Practice Address - Street 1:303 FLEISCHMANN WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-2913
Practice Address - Country:US
Practice Address - Phone:775-885-7827
Practice Address - Fax:775-885-2301
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3413005Medicaid
NVV31943Medicare PIN