Provider Demographics
NPI:1821206889
Name:TUCKER, MARY MARGARET (LMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
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 1:3001 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-8939
Mailing Address - Country:US
Mailing Address - Phone:407-383-3036
Mailing Address - Fax:
Practice Address - Street 1:3001 MALLARD DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-8939
Practice Address - Country:US
Practice Address - Phone:407-383-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM32768172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist