Individual
TIMOTHY O'DELL PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
7007 BANDERA RD STE 3, LEON VALLEY, TX 78238-1264
(210) 387-6993
(210) 855-2542
Mailing address
12047 STONEY XING, SAN ANTONIO, TX 78247-3453
(210) 387-6993
(210) 855-2542
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1206227
TX
2251S0007X
Sports Physical Therapist
1206227
TX
2251X0800X
Orthopedic Physical Therapist
Primary
1206227
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12284562
CAQH
TX
05
—
290438501
—
TX
01
—
867T19
BCBSTX
TX
Enumeration date
06/23/2011
Last updated
05/04/2018
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