Healthcare Provider Details

I. General information

NPI: 1831492487
Provider Name (Legal Business Name): SUZANNE PUCKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 EASTERN BY-PASS
RICHMOND KY
40475
US

IV. Provider business mailing address

3425 EXECUTIVE PKWY SUITE 128
TOLEDO OH
43606-1326
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-6334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT002420
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: