Individual
MRS. JOHNNIE L PUCCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA, LMT
Contact information
Practice address
2129 W NEW HAVEN AVE, W MELBOURNE, FL 32904-3875
(321) 723-8299
Mailing address
2560 QUARRY AVE SE, PALM BAY, FL 32909-7270
(321) 676-4816
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA19316
FL
Other
Enumeration date
05/05/2011
Last updated
05/05/2011
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