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NPI Code Detail

MEDICARE: MR. GARRY LANE TUCKER P.T.

MEDICARE: MR. GARRY LANE TUCKER P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251G0304XGeriatric Physical Therapist003618KY

General Provider Information

NPI Number : 1710221320
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GARRY LANE TUCKER P.T.
Provider Business Mailing Address
First Line : 280 MOORMAN LN
Second Line :
City : BOWLING GREEN
State : KY
Zip : 42101-0711
Country : US
Telephone Number : 270-792-1261
Fax Number :
Provider Business Practice Location Address
First Line : 813 S MAIN ST
Second Line :
City : BROWNSVILLE
State : KY
Zip : 42210-9009
Country : US
Telephone Number : 270-597-2335
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2012
Last Update Date : 11/20/2012

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