MEDICARE: ALBERT PUCKETT PT, MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5088	AZ

General Provider Information

NPI Number	:	1225139421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT PUCKETT PT, MPT

Provider Business Mailing Address
First Line	:	5956 E PIMA ST.
Second Line	:	SUITE 140
City	:	TUCSON
State	:	AZ
Zip	:	85712
Country	:	US
Telephone Number	:	520-885-4636
Fax Number	:	520-885-4736

Provider Business Practice Location Address
First Line	:	5956 E PIMA ST.
Second Line	:	SUITE 140
City	:	TUCSON
State	:	AZ
Zip	:	85712
Country	:	US
Telephone Number	:	520-885-4636
Fax Number	:	520-885-4736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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