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General NPI Number Information
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NPI Number | 1831989805
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Entity Type | Individual
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Provider Name | CAMDEN BLAKE TUCKER DPT
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Gender | Male
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 39546 AL HIGHWAY 69
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City | MOUNDVILLE
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State | AL
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Zip | 35474-4238
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Country | US
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Telephone | 205-450-9114
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Fax |
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Provider Business Mailing Address
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Address Line | 245 CAHABA VALLEY PKWY
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City | PELHAM
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State | AL
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Zip | 35124-2216
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Country | US
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Telephone | 205-942-6820
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Fax | 205-421-0900
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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 | 2-1443
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License Number State | AL
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