MEDICARE: MICHAEL C PUTT PT

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	PT2390	MS
2	225100000X	Physical Therapist	PTH5787	AL

General Provider Information

NPI Number	:	1598757841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL C PUTT PT

Provider Business Mailing Address
First Line	:	2429 5TH ST N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2005
Country	:	US
Telephone Number	:	662-328-4542
Fax Number	:	662-328-4783

Provider Business Practice Location Address
First Line	:	2429 5TH ST N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2005
Country	:	US
Telephone Number	:	662-328-4542
Fax Number	:	662-328-4783

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	01/02/2013

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