| NPI | 1174172464 |
|---|---|
| Former Name | DANIELLE NICOLE PUCKETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT018945) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 4896) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2020-11-16 |