Provider Demographics
NPI:1528063054
Name:TUCKER, ROSANNE (MPT)
Entity type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ROSANNE
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1305 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5705
Mailing Address - Country:US
Mailing Address - Phone:304-242-1390
Mailing Address - Fax:304-243-5880
Practice Address - Street 1:1305 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5705
Practice Address - Country:US
Practice Address - Phone:304-242-1390
Practice Address - Fax:304-243-5880
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4151732OtherWV MEDICARE PTAN
WV7305199000Medicaid
WV4151732OtherWV MEDICARE PTAN
OHCA4151701Medicare ID - Type Unspecified