Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 8580933-2401 | UT |
NPI | 1265870232 |
---|---|
Provider Name | Kara Kimiko Tucker |
First Address | Salt Lake City, UT 84151-0721 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2013 |
Last Update Date | 20/12/2021 |