Individual
BETHANY L TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
840 HAMMOND ST STE 2, BANGOR, ME 04401-4339
(207) 433-7778
(866) 220-5031
Mailing address
100 ST LOUIS AVE, HERMON, ME 04401-0874
(207) 991-7412
(866) 220-5031
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3176
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099276
BLUE CROSS & BLUE SHIELD
ME
01
—
P00369309
RAILROAD MEDICARE
ME
01
—
PT3176
PT LICENSE
ME
Enumeration date
09/21/2006
Last updated
03/13/2013
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