Individual
MARIAN PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
789 TENNESSEE ST, BOLIVAR, TN 38008-2441
(731) 658-2206
(731) 659-2061
Mailing address
235 HANNIS RD, BOLIVAR, TN 38008-4107
(731) 658-2500
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0000001854
TN
Other
Enumeration date
02/06/2007
Last updated
07/08/2007
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