Healthcare Provider Details

I. General information

NPI: 1447526843
Provider Name (Legal Business Name): ANDREW JOHN PUCH MA, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SMITH KRAMER ST NE
HARTVILLE OH
44632-9467
US

IV. Provider business mailing address

1600 SMITH KRAMER ST NE
HARTVILLE OH
44632-9467
US

V. Phone/Fax

Practice location:
  • Phone: 516-810-7521
  • Fax:
Mailing address:
  • Phone: 516-810-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012733
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: