MEDICARE: REBECCA TUCKER ATC

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	2255A2300X	Athletic Trainer	926	SC

General Provider Information

NPI Number	:	1700248283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA TUCKER ATC

Provider Business Mailing Address
First Line	:	411 MERCANTILE PLACE
Second Line	:	SUITE 101
City	:	FORT MILL
State	:	SC
Zip	:	29715
Country	:	US
Telephone Number	:	704-741-4946
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 MERCANTILE PLACE
Second Line	:	SUITE 101
City	:	FORT MILL
State	:	SC
Zip	:	29715
Country	:	US
Telephone Number	:	704-741-4946
Fax Number	:

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

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	03/09/2026

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