Provider Demographics
NPI:1881992915
Name:TUCKER, CLARENCE E JR (PT)
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:E
Last Name:TUCKER
Suffix:JR
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 1:301 RIVERVIEW AVE
Mailing Address - Street 2:SUITE 525A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-963-5588
Mailing Address - Fax:757-963-2333
Practice Address - Street 1:301 RIVERVIEW AVE
Practice Address - Street 2:SUITE 525A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-963-5588
Practice Address - Fax:757-963-2333
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist