Provider Demographics
NPI:1366576779
Name:TUCKER, DALE AGNES (LPTA)
Entity type:Individual
Prefix:MRS
First Name:DALE
Middle Name:AGNES
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 COUNTY ROAD 200
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2309
Mailing Address - Country:US
Mailing Address - Phone:352-748-6033
Mailing Address - Fax:
Practice Address - Street 1:600 W NORTH BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5063
Practice Address - Country:US
Practice Address - Phone:352-787-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 1561225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant