Kenneth A Tucker, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT006218 Issued in CA

Practice address

711 D St
#102
San Rafael, CA 94901-3707

Phone

(415) 456-3551

Fax

(415) 457-7260

NPI assigned

Mar 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281398400000",
    "number": "1225006430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 D ST",
            "address_2": "#102",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013707",
            "telephone_number": "415-456-3551",
            "fax_number": "415-457-7260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 D ST",
            "address_2": "#102",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013707",
            "telephone_number": "415-456-3551",
            "fax_number": "415-457-7260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "KENNETH",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2010-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT006218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID#",
            "identifier": "94-6366835",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Rosalind Truax, MFT
• Alberto Gabriel Trujillo, PEER SPECIALIST
• Krisna Truong
• Jaime Ross Tschirki
• Tiffanie Pei-Ling Tse, M.D.
• David Michael Tully-Smith, M.D.
• Rami John Turk, MD
• Marion Turner-Riley, MARION TURNER-RILEY
• Rachel Turner, PSYD
• Wendi Turner, D. C.

• Physical Therapist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.