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General NPI Number Information
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NPI Number | 1184910507
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Entity Type | Individual
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Provider Name | TIMOTHY O'DELL PUCKETT DPT
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Gender | Male
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 7007 BANDERA RD STE 3
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City | LEON VALLEY
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State | TX
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Zip | 78238-1264
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Country | US
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Telephone | 210-387-6993
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Fax | 210-855-2542
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Provider Business Mailing Address
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Address Line | 12047 STONEY XING
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City | SAN ANTONIO
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State | TX
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Zip | 78247-3453
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Country | US
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Telephone | 210-387-6993
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Fax | 210-855-2542
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1206227
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 1206227
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1206227
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License Number State | TX
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