MEDICARE: MRS. TARA J TUCKER-ROBERTS PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA25075	FL
2	225200000X	Physical Therapy Assistant	PTA48572	CA

General Provider Information

NPI Number	:	1588060222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA J TUCKER-ROBERTS PTA

Provider Business Mailing Address
First Line	:	2349 WATERFALL DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-4644
Country	:	US
Telephone Number	:	352-345-7285
Fax Number	:

Provider Business Practice Location Address
First Line	:	2349 WATERFALL DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-4644
Country	:	US
Telephone Number	:	352-345-7285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2014
Last Update Date	:	04/26/2017

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