Provider Demographics
NPI:1700358215
Name:PUENTE, ALBERT JACOB (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:JACOB
Last Name:PUENTE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-2662
Mailing Address - Country:US
Mailing Address - Phone:254-640-3306
Mailing Address - Fax:
Practice Address - Street 1:1101 NORTH Q AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76708
Practice Address - Country:US
Practice Address - Phone:254-640-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT50252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer