Individual
PHILLIP TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
12613 S WESTERN AVE, OKLAHOMA CITY, OK 73170-6903
(405) 735-4800
Mailing address
2609 SE 7TH ST, MOORE, OK 73160-6776
(580) 214-0782
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
695
OK
Other
Enumeration date
11/17/2015
Last updated
11/17/2015
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