Breonna S Tucker, PT,DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

29797 Issued in MD

Practice address

3018 Festival Way # 323
Waldorf, MD 20601-2958

Phone

(240) 754-5520

Fax

(301) 705-6797

NPI assigned

Jan 11, 2024

Last updated

Feb 5, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD, DC2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ati Holdings, LLCGroup PAC ID 9537112719, 440 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ati Holdings, LLC

  dba ATI Physical Therapy

  • Physical Therapy Clinic/Center
  • Rising Sun, MD
  • NPI 1396781050

  DC, Physical Therapist

  Medicare reassignment Care Compare group NPD
• Centers for Advanced Orthopaedics, LLC

  • Orthopaedic Surgery Physician
  • Olney, MD
  • NPI 1487093167
  Medicare reassignment
• Ati Holdings, LLC

  • Durable Medical Equipment & Medical Supplies
  • King of Prussia, PA
  • NPI 1750194460

  Physical Therapist

  NPD
• Ati Holding LLC

  dba ATI Physical Therapy

  • Physical Therapist
  • Waldorf, MD
  • NPI 1437634250
  NPD (past)
• Ati Holdings, LLC

  dba ATI Physical Therapy Waldorf

  • Physical Therapist
  • Waldorf, MD
  • NPI 1215319041
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1134990815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3018 FESTIVAL WAY # 323",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206012958",
            "telephone_number": "240-754-5520",
            "fax_number": "301-705-6797"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3018 Festival Way Unit 323",
            "address_purpose": "LOCATION",
            "city": "Waldorf",
            "state": "MD",
            "postal_code": "206012958",
            "country_code": "US",
            "telephone_number": "240-754-5520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "BREONNA",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "PT,DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-11",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "29797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Marie Truitt, RN
• Maureen Tschiegg, OTR/L
• Azuasie Patience Tsomukong
• Tuan D Pham DMD & Joseph a Maloney DDS, LLC
• Atchafala M Tucker, LCPC
• Turner Psychological Counseling
• Tawaka Jones Turner-Philon
• James Guy Turner Jr., LCPC
• Tiffany Chu Turner, DDS
• Corrie E Turpin

• Physical Therapist in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.