Healthcare Provider Details

I. General information

NPI: 1619743440
Provider Name (Legal Business Name): TUCKER METHOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5268 CENTRAL AVE
FREMONT CA
94536-6533
US

IV. Provider business mailing address

1179 W A ST # 140
HAYWARD CA
94541-7006
US

V. Phone/Fax

Practice location:
  • Phone: 510-578-8155
  • Fax:
Mailing address:
  • Phone: 510-999-2357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JASON TUCKER
Title or Position: OWNER
Credential: NMT, CMT, CPT, BRM
Phone: 510-999-2357