Provider Demographics
NPI:1396124277
Name:TUCKER, HAILEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:
Other - Last Name:JUNGEBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:860 LIVERMORE LN
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-3012
Mailing Address - Country:US
Mailing Address - Phone:440-315-1289
Mailing Address - Fax:
Practice Address - Street 1:4210 TELEGRAPH LN
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-3748
Practice Address - Country:US
Practice Address - Phone:440-967-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0124842251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics