Individual
JAKE PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
1212 MARKET ST, LA GRANGE, KY 40031-7986
(502) 225-9981
Mailing address
1212 MARKET ST, LA GRANGE, KY 40031-7986
(502) 225-9981
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
008866
KY
Other
Enumeration date
08/03/2023
Last updated
08/08/2023
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