Individual
EDWARD CARROLL PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
400 G CRESTWOOD CIRCLE, MENA, AR 71953-5512
(479) 394-7979
(479) 394-7667
Mailing address
128 VALLEE HI, MENA, AR 71953
(479) 394-3026
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 2623
AR
Other
Enumeration date
04/20/2007
Last updated
07/08/2007
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