Healthcare Provider Details

I. General information

NPI: 1558406785
Provider Name (Legal Business Name): DEBRA NICOLE TRUITT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504A CHERRY ST BUILDING D
BLUEFIELD WV
24701-3306
US

IV. Provider business mailing address

PO BOX 149
SPANISHBURG WV
25922-0149
US

V. Phone/Fax

Practice location:
  • Phone: 304-327-8686
  • Fax: 304-324-0548
Mailing address:
  • Phone: 304-920-0100
  • Fax: 304-324-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2000-0453
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: