Provider Demographics
NPI:1023501749
Name:PUCKETT, SHERYL LYNN
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:LYNN
Last Name:PUCKETT
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 1:522 E MARION AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3803
Mailing Address - Country:US
Mailing Address - Phone:941-639-8273
Mailing Address - Fax:941-639-8294
Practice Address - Street 1:522 E MARION AVE STE 202
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3803
Practice Address - Country:US
Practice Address - Phone:941-639-8273
Practice Address - Fax:941-639-8294
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant