Provider Demographics
NPI:1609674787
Name:TUCKER, KRISTOPHER (PTA)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:
Last Name:TUCKER
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1767
Mailing Address - Country:US
Mailing Address - Phone:940-631-0225
Mailing Address - Fax:940-692-8388
Practice Address - Street 1:1 W MEDICAL CT
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1767
Practice Address - Country:US
Practice Address - Phone:940-692-4688
Practice Address - Fax:940-692-8388
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2089761225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant