Active NPI
Edward Carroll Puckett, PT
- Physical Therapist
- Mena, AR
National Provider Identifier
1275750044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 2623
- Practice address
- 400 G Crestwood Circle
Mena, AR 71953-5512 - Phone
- (479) 394-7979
- Fax
- (479) 394-7667
- NPI assigned
- Apr 20, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 2623 | AR | Primary |
Addresses
Primary practice location
400 G Crestwood Circle
Mena, AR 71953-5512
Mailing address
128 Vallee Hi
Mena, AR 71953
Phone (479) 394-3026
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 2623 | AR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275750044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "128 VALLEE HI",
"city": "MENA",
"state": "AR",
"postal_code": "71953",
"telephone_number": "479-394-3026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 G CRESTWOOD CIRCLE",
"city": "MENA",
"state": "AR",
"postal_code": "719535512",
"telephone_number": "479-394-7979",
"fax_number": "479-394-7667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "EDWARD",
"middle_name": "CARROLL",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "PT 2623",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mena, AR
- Amy Lanelle Phelps, APRN
- Lana Kay Philpot, PTA
- Polk County Developmental Center, Inc.
- Polk Operations, LLC (Rich Mountain Nursing and Rehab Center)
- Presidential Emergency Physicians, LLC
- Kervin T Putman, DC
- Ginny Reding, LAC, LAMFT
- Regina Rowland Speech Therapy Services, Inc
- Bradley Renick
- Rich Mountain Chiropractic, PLLC (Rich Mountain Chiropractic)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.