Healthcare Provider Details

I. General information

NPI: 1487547923
Provider Name (Legal Business Name): ABBY LEIGH PUCKETT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 HEDGE LANE TER
SHAWNEE KS
66226-2255
US

IV. Provider business mailing address

4712 ROANOKE PKWY APT 702
KANSAS CITY MO
64112-1676
US

V. Phone/Fax

Practice location:
  • Phone: 913-391-4550
  • Fax:
Mailing address:
  • Phone: 405-537-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-07893
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: