Provider Demographics
NPI:1841775400
Name:PUETZ, EMILY RENEE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RENEE
Last Name:PUETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BROOKSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-8420
Mailing Address - Country:US
Mailing Address - Phone:316-706-7084
Mailing Address - Fax:
Practice Address - Street 1:109 BROOKSTONE CIR
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-8420
Practice Address - Country:US
Practice Address - Phone:316-706-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty