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General NPI Number Information
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NPI Number | 1881992915
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Entity Type | Individual
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Provider Name | CLARENCE E TUCKER JR. MSPT
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Gender | Male
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 500 RODMAN AVENUE SUITE 3
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City | PORTSMOUTH
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State | VA
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Zip | 23707
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Country | US
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Telephone | 757-393-6119
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Fax | 757-393-0681
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Provider Business Mailing Address
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Address Line | 729 THIMBLE SHOALS BLVD SUITE 4A
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4217
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Country | US
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Telephone | 757-597-9510
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Fax | 757-597-9514
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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 |
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License Number State |
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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 | 2305202186
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License Number State | VA
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