Individual
MR. DEREK WADE PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
3000 HWY 49 SOUTH, FLORENCE, MS 39073
(601) 845-8282
(601) 845-8290
Mailing address
3000 HWY 49 SOUTH, FLORENCE, MS 39073
(601) 845-8282
(601) 845-8290
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1702
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00116390
—
MS
Enumeration date
10/02/2006
Last updated
03/23/2011
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