Healthcare Provider Details

I. General information

NPI: 1235506080
Provider Name (Legal Business Name): DANIEL PUCHSTEIN LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 BARNES MILL RD APT 1424
MARIETTA GA
30062-7568
US

IV. Provider business mailing address

1650 BARNES MILL RD APT 1424
MARIETTA GA
30062-7568
US

V. Phone/Fax

Practice location:
  • Phone: 770-403-3244
  • Fax:
Mailing address:
  • Phone: 770-403-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA003495
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: