Provider Demographics
NPI:1124527304
Name:TUCKER, ANNA KAY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:KAY
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 JIMAT DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-1758
Mailing Address - Country:US
Mailing Address - Phone:817-542-1377
Mailing Address - Fax:
Practice Address - Street 1:1345 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-6943
Practice Address - Country:US
Practice Address - Phone:214-743-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1301497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist