Provider Demographics
NPI:1699509646
Name:TUCKER, BEVIN MARY KASSANDRA (PT, DPT, CBIS)
Entity type:Individual
Prefix:
First Name:BEVIN
Middle Name:MARY KASSANDRA
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PT, DPT, CBIS
Other - Prefix:
Other - First Name:BEVIN
Other - Middle Name:
Other - Last Name:MRAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 HANSKA CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8604
Mailing Address - Country:US
Mailing Address - Phone:512-851-6267
Mailing Address - Fax:
Practice Address - Street 1:2301 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4699
Practice Address - Country:US
Practice Address - Phone:919-681-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist