Provider Demographics
NPI:1952798282
Name:TUCKER, STEPHEN BRADLEY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BRADLEY
Last Name:TUCKER
Suffix:
Gender:M
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 1:539 MENZIES DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-7472
Mailing Address - Country:US
Mailing Address - Phone:803-322-2499
Mailing Address - Fax:
Practice Address - Street 1:231 S HERLONG AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1159
Practice Address - Country:US
Practice Address - Phone:803-366-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7470225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist