Individual
TUCKER J BENJAMIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATS
Contact information
Practice address
W11052 457TH AVE, PRESCOTT, WI 54021-7657
(651) 890-7110
Mailing address
W11052 457TH AVE, PRESCOTT, WI 54021-7657
(651) 890-7110
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/06/2016
Last updated
10/06/2016
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