Provider Demographics
NPI:1770271959
Name:TUCKER, HALEY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:HALEY
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 EMPIRE DR APT 5119
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-0107
Mailing Address - Country:US
Mailing Address - Phone:817-707-8098
Mailing Address - Fax:
Practice Address - Street 1:1652 KELLER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3876
Practice Address - Country:US
Practice Address - Phone:817-562-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1372619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1372619OtherPT LICENSE