Provider Demographics
NPI:1588060222
Name:TUCKER-ROBERTS, TARA J (PTA)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:J
Last Name:TUCKER-ROBERTS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 WATERFALL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-4644
Mailing Address - Country:US
Mailing Address - Phone:352-345-7285
Mailing Address - Fax:
Practice Address - Street 1:2349 WATERFALL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-4644
Practice Address - Country:US
Practice Address - Phone:352-345-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA25075225200000X
CAPTA48572225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant