Basic Information
| Provider Information | |||||||||
| NPI: | 1841423548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUCKER | ||||||||
| FirstName: | CAITLIN | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | M.P.T, B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 OLD CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | EAST FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025364424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7743920150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 PARKMAN ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021143117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177240125 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2009 | ||||||||
| LastUpdateDate: | 08/27/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 18785 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.