Provider Demographics
NPI:1154706455
Name:TUCKER, MARSHA (LPTA)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4732 UPPER BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-3690
Mailing Address - Country:US
Mailing Address - Phone:770-316-8159
Mailing Address - Fax:
Practice Address - Street 1:4732 UPPER BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3690
Practice Address - Country:US
Practice Address - Phone:770-316-8159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA000960225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant