Provider Demographics
NPI:1366796492
Name:TUCKER, CHRISTEN ANIESE (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:ANIESE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13650 MARINA POINTE DR
Mailing Address - Street 2:UNIT 1006
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-9285
Mailing Address - Country:US
Mailing Address - Phone:315-256-5574
Mailing Address - Fax:
Practice Address - Street 1:3283 MOTOR AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3709
Practice Address - Country:US
Practice Address - Phone:310-845-9690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37135225100000X
NY035036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist