Healthcare Provider Details

I. General information

NPI: 1588060222
Provider Name (Legal Business Name): TARA J TUCKER-ROBERTS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 WATERFALL DR
SPRING HILL FL
34608-4644
US

IV. Provider business mailing address

2349 WATERFALL DR
SPRING HILL FL
34608-4644
US

V. Phone/Fax

Practice location:
  • Phone: 352-345-7285
  • Fax:
Mailing address:
  • Phone: 352-345-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA25075
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA48572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: