MEDICARE: NICOLE ROCHELLE TUCKER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1406964	TX
2	225100000X	Physical Therapist	PT28014	FL

General Provider Information

NPI Number	:	1558674762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ROCHELLE TUCKER DPT

Provider Business Mailing Address
First Line	:	814 N MAIN ST
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-4564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	814 N MAIN ST
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-4564
Country	:	US
Telephone Number	:	724-816-1731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	03/18/2026

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Directions to “ NICOLE ROCHELLE TUCKER DPT” Practice Location

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