Individual
MR. JOHN O'DELL TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
535 HIGHWAY 314 SW, LOS LUNAS, NM 87031-9600
(505) 866-0055
(505) 866-0057
Mailing address
535 HIGHWAY 314 SW, LOS LUNAS, NM 87031-9600
(505) 866-0055
(505) 866-0057
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
458
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000Q0406
—
NM
01
—
DC4165
RR MEDICARE
NM
Enumeration date
08/09/2006
Last updated
04/21/2014
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