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1194089359
NICOLE RENEE TUCKER
DECATUR, IL
NPI
1194089359
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: IL 160005008)
Enumeration Date
2012-07-02
Last Update Date
2012-07-02
Business Address
Mrs. NICOLE RENEE TUCKER
2300 N EDWARD ST
DECATUR, IL 62526-4163
Phone number: 217-876-2600
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Mailing Address
Mrs. NICOLE RENEE TUCKER
2300 N EDWARD ST
DECATUR, IL 62526-4163
Phone number: 217-876-2600
Copy
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