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General NPI Number Information
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NPI Number | 1093252900
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Entity Type | Individual
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Provider Name | PAMELA O TUCKER PT DPT
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Gender | Female
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 304 MARCELLA RD STE E
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City | HAMPTON
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State | VA
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Zip | 23666
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Country | US
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Telephone | 757-825-9446
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Fax | 757-825-9476
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Provider Business Mailing Address
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Address Line | 729 THIMBLE SHOALS BLVD STE STE 4-C
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City | NEWPORT NEWS
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State | VA
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Zip | 23606
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Country | US
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Telephone | 757-873-2932
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Fax | 757-873-8780
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305204128
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License Number State | VA
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