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General NPI Number Information
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NPI Number | 1467907436
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Entity Type | Organization
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Legal Business Name | TUCKEY AND ASSOCIATES PHYSICAL THERAPY SERVICES INC.
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 6239 ROSEBURY AVE 2 W
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City | SAINT LOUIS
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State | MO
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Zip | 63105-3221
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Country | US
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Telephone | 314-265-7616
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Fax | 314-571-9418
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Provider Business Mailing Address
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Address Line | 6239 ROSEBURY AVE 2 W
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City | SAINT LOUIS
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State | MO
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Zip | 63105-3221
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Country | US
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Telephone | 314-265-7616
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Fax | 314-571-9418
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL PATRICK TUCKEY
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Credential | PT
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Telephone | 314-265-7616
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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 | 070.002146
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | RO567
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License Number State | MO
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