Individual
LANCE TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4437 RICHMOND AVE, SHREVEPORT, LA 71106-1419
(318) 272-6125
Mailing address
4437 RICHMOND AVE, SHREVEPORT, LA 71106-1419
(318) 272-6125
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
06586R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06586R
PRIVATE PAY
LA
Enumeration date
03/11/2021
Last updated
06/10/2025
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