MEDICARE: KATIE MARIE PRUKA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P13906	NC

General Provider Information

NPI Number	:	1992054266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE MARIE PRUKA PT

Provider Business Mailing Address
First Line	:	5213 S ALSTON AVE
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-4430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 DUKE HEALTH CARY PL STE 130
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-6760
Country	:	US
Telephone Number	:	919-385-4250
Fax Number	:	919-385-4251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2012
Last Update Date	:	03/02/2023

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Directions to “ KATIE MARIE PRUKA PT” Practice Location

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