Provider Demographics
NPI:1447933122
Name:TUCKER, EMILY MICHELLE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MICHELLE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 EMERALD PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2380
Mailing Address - Country:US
Mailing Address - Phone:916-685-2240
Mailing Address - Fax:916-686-2240
Practice Address - Street 1:8920 EMERALD PARK DR STE C
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2380
Practice Address - Country:US
Practice Address - Phone:916-685-2240
Practice Address - Fax:916-686-2240
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37027225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist