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General NPI Number Information
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NPI Number | 1154148344
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Entity Type | Individual
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Provider Name | COLTON TUCKER DPT
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Gender | Male
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Dates
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Enumeration Date | 09/20/2024
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 1201 S CLEARVIEW PKWY BLDG B
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City | NEW ORLEANS
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State | LA
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Zip | 70121-1015
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Country | US
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Telephone | 504-734-1472
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7902
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City | MONROE
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State | LA
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Zip | 71211-7902
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Country | US
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Telephone |
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Fax |
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | SP232744
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License Number State |
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