Individual
MRS. DALE AGNES TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
600 W NORTH BLVD, SUITE D, LEESBURG, FL 34748-5063
(352) 787-9300
Mailing address
2845 COUNTY ROAD 200, OXFORD, FL 34484-2309
(352) 748-6033
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 1561
FL
Other
Enumeration date
03/15/2007
Last updated
07/08/2007
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