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General NPI Number Information
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NPI Number | 1699654400
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Entity Type | Individual
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Provider Name | JILLIAN TUCKER DPT, PT
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Gender | Female
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 2745 SANDY PLAINS RD STE 154
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City | MARIETTA
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State | GA
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Zip | 30066-4396
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Country | US
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Telephone | 770-783-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 153 WOODLAWN AVE
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City | DECATUR
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State | GA
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Zip | 30030-2310
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT017879
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License Number State | GA
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