Individual
BRANDE PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
3356 VINEVILLE AVE, MACON, GA 31204-2328
(478) 476-9642
Mailing address
7045 HOPEWELL RD E, MUSELLA, GA 31066-3421
(478) 951-1937
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
001605
GA
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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