Individual
MRS. NICOLE RENEE TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2300 N EDWARD ST, DECATUR, IL 62526-4163
(217) 876-2600
(217) 876-2615
Mailing address
2300 N EDWARD ST, DECATUR, IL 62526-4163
(217) 876-2600
(217) 876-2615
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160005008
IL
Other
Enumeration date
07/02/2012
Last updated
07/02/2012
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