Provider Demographics
NPI:1902586704
Name:TUCKER, BRENDA GALE (LMT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:GALE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 BENEVA RD
Mailing Address - Street 2:UNIT 407
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233
Mailing Address - Country:US
Mailing Address - Phone:941-350-9178
Mailing Address - Fax:
Practice Address - Street 1:3148 SOUTHGATE CIRCLE
Practice Address - Street 2:SOUTHGATE MASSAGE & WELLNESS CENTER
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-350-9178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA20927172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist