Provider Demographics
NPI:1396144416
Name:LOUCKS, TRICIA (PTA)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:LOUCKS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 CROCKETT ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79110-3307
Mailing Address - Country:US
Mailing Address - Phone:806-584-4991
Mailing Address - Fax:
Practice Address - Street 1:1619 S KENTUCKY ST. F600
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102
Practice Address - Country:US
Practice Address - Phone:806-373-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2103558225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant