Pamela Ann Tucker, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1043859 Issued in TX

Practice address

6080 Southwest Blvd
Benbrook, TX 76109-3912

Phone

(817) 731-9331

NPI assigned

Sep 16, 2006

Sex

Female

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

Other names 1

• Pamela Ann Jackson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Ideal Physical Therapy of Texas LLC

  • Durable Medical Equipment & Medical Supplies
  • Murphy, TX
  • NPI 1902773161
  NPD (past)

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292198400000",
    "number": "1568568558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6317 LAVANO DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761342828",
            "telephone_number": "817-551-0806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6080 SOUTHWEST BLVD",
            "city": "BENBROOK",
            "state": "TX",
            "postal_code": "761093912",
            "telephone_number": "817-731-9331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "PAMELA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-16",
        "last_updated": "2010-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1043859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD TX",
            "identifier": "8T6758",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAMELA",
            "last_name": "JACKSON",
            "middle_name": "ANN",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Connor M Trigg
• Trinity Holistic Family Medicine, P.a.
• Trocchio Training LLC
• Steve Trocchio, PT
• Trumed LLC
• Kimberly Dawn Turner, MED, BCBA
• Sarah Lane Tyson, PTA
• United Investors LP
• Chelsea Vale, M.A., BCBA
• Rebekah Varela

• Physical Therapist in Benbrook, TX
• Providers in Benbrook, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 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.