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Individual
ELISSA V VEGA-TUCKER
Active
Individual
ELISSA V VEGA-TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
025861
NY
2251P0200X
Pediatric Physical Therapist
025861
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02528696
—
NY
Enumeration date
09/12/2005
Last updated
10/08/2018
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