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General NPI Number Information
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NPI Number | 1568568558
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Entity Type | Individual
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Provider Name | PAMELA ANN TUCKER PT
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 6080 SOUTHWEST BLVD
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City | BENBROOK
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State | TX
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Zip | 76109-3912
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Country | US
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Telephone | 817-731-9331
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Fax |
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Provider Business Mailing Address
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Address Line | 6317 LAVANO DR
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City | FORT WORTH
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State | TX
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Zip | 76134-2828
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Country | US
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Telephone | 817-551-0806
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1043859
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License Number State | TX
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