Provider Demographics
NPI:1952165532
Name:YARBOROUGH, TUCKER (PT, DPT, CERT DN)
Entity Type:Individual
Prefix:
First Name:TUCKER
Middle Name:
Last Name:YARBOROUGH
Suffix:
Gender:M
Credentials:PT, DPT, CERT DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 TRAMWAY RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-7142
Mailing Address - Country:US
Mailing Address - Phone:919-775-6160
Mailing Address - Fax:
Practice Address - Street 1:3112 TRAMWAY RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-7142
Practice Address - Country:US
Practice Address - Phone:919-775-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist