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General NPI Number Information
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NPI Number | 1366576779
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Entity Type | Individual
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Provider Name | DALE AGNES TUCKER LPTA
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 600 W NORTH BLVD SUITE D
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City | LEESBURG
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State | FL
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Zip | 34748-5063
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Country | US
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Telephone | 352-787-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 2845 COUNTY ROAD 200
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City | OXFORD
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State | FL
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Zip | 34484-2309
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Country | US
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Telephone | 352-748-6033
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA 1561
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License Number State | FL
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