Amy Puckett, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305211396 Issued in VA

Practice address

4600 Brambleton Ave Ste B
Roanoke, VA 24018-3437

Phone

(540) 774-0729

NPI assigned

Jan 8, 2024

Sex

Female

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

Enrolled in VA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Functional Pathways Preferred of Tennessee LLC

  • Physical Therapist
  • Knoxville, TN
  • NPI 1841561446

  VA

  Medicare reassignment NPD

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1376313569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 DAVIS ST STE B",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240607009",
            "telephone_number": "540-774-0729",
            "fax_number": "540-774-0862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 BRAMBLETON AVE STE B",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240183437",
            "telephone_number": "540-774-0729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "AMY",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305211396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Ryan Pryor, M.D.
• Megan Pryor
• Mollie Catherine Przybocki
• Psychological Health Roanoke PC
• Theresa Ptakowski, M.S., CCC-SLP
• Paige S Puckett, L.P.T.A.
• Whitney Harlow Pugh, NP
• Christine Marina Pujol Rooks
• Derrick Jeffrey Pullen Jr.
• Keith Gabriel Pullen

• Physical Therapist in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.