Individual
JENNY TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
206 MARYLAND AVE, MCCOMB, MS 39648-3926
(601) 250-4815
Mailing address
9866 HWY 495, APT A, MERIDIAN, MS 39305-9214
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA3111
MS
Other
Enumeration date
03/05/2008
Last updated
03/05/2008
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