Colton Judson Puckett, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2080660 Issued in TX

Practice address

395 County Road 3101
Clarksville, TX 75426-6905

Phone

(903) 249-0386

Fax

(903) 427-8256

NPI assigned

Jul 5, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341446400000",
    "number": "1205191269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 COUNTY ROAD 3101",
            "city": "CLARKSVILLE",
            "state": "TX",
            "postal_code": "754266905",
            "telephone_number": "903-249-0386",
            "fax_number": "903-427-8256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 COUNTY ROAD 3101",
            "city": "CLARKSVILLE",
            "state": "TX",
            "postal_code": "754266905",
            "telephone_number": "903-249-0386",
            "fax_number": "903-427-8256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "COLTON",
        "middle_name": "JUDSON",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-05",
        "last_updated": "2012-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2080660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nexion Health at Bogata, Inc. (Regency Healthcare and Rehabilitation Center at Red River)
• Paris Medical Supply, Inc. (Pro Care Services)
• Misty Dawn Perez, PHARM D
• Physical Therapy Clinic of Paris, LP
• PRMC Healthcare Group Inc (Clarksville Family Clinic)
• Thomas Virgil Ragan Jr., D.D.S.
• Lacy M Raney
• Red River Emergency Medicine Associates PA
• Rivercrest I.S.D.
• Michael Leroy Roan, MA/CCC-SLP

• Physical Therapy Assistant in Clarksville, TX
• Providers in Clarksville, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.