Provider Demographics
NPI:1932262060
Name:TUCKER, JAMES GERALD (PT PHYSICAL THERAPIS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GERALD
Last Name:TUCKER
Suffix:
Gender:M
Credentials:PT PHYSICAL THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:15 SEASCAPE VILLAGE
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003
Mailing Address - Country:US
Mailing Address - Phone:831-687-0985
Mailing Address - Fax:831-687-0986
Practice Address - Street 1:15 SEASCAPE VILLAGE
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003
Practice Address - Country:US
Practice Address - Phone:831-687-0985
Practice Address - Fax:831-687-0986
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA673905OtherACN GROUP OF CA
CAOPT204630OtherBLUE SHIELD OF CA
CA673905OtherACN GROUP OF CA