Individual
CHARLES MAHLON TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
112 W CITRUS ST, ALTAMONTE SPRINGS, FL 32714-2502
(407) 865-5642
Mailing address
623 N HYER AVE, ORLANDO, FL 32803-4629
(786) 368-4791
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA29584
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA29584
DOH NUMBER
FL
Enumeration date
10/21/2019
Last updated
11/27/2023
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