Individual
COREY TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
601 S MAIN ST STE 105, KELLER, TX 76248-7027
(972) 393-8067
Mailing address
6420 RIVERTRAIL CIR APT 117, ARLINGTON, TX 76001-1136
(270) 945-5000
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2142409
TX
Other
Enumeration date
10/09/2018
Last updated
10/09/2018
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