Provider Demographics
NPI:1881760361
Name:TUCKER, STEVEN ROY (PT)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ROY
Last Name:TUCKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11039 DUGWAY RD
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14735-8610
Mailing Address - Country:US
Mailing Address - Phone:585-567-2232
Mailing Address - Fax:585-567-2239
Practice Address - Street 1:11039 DUGWAY RD
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:NY
Practice Address - Zip Code:14735-8610
Practice Address - Country:US
Practice Address - Phone:585-567-2232
Practice Address - Fax:585-567-2239
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA5560Medicare ID - Type Unspecified