Provider Demographics
NPI:1710975339
Name:TUCCIO, MICHAEL DOMENIC (DPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DOMENIC
Last Name:TUCCIO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:13601 LYTTON WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2540
Mailing Address - Country:US
Mailing Address - Phone:813-317-5486
Mailing Address - Fax:813-602-0164
Practice Address - Street 1:31608 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3723
Practice Address - Country:US
Practice Address - Phone:813-317-5486
Practice Address - Fax:813-602-0164
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2020-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPT20245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist