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General NPI Number Information
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NPI Number | 1003520347
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Entity Type | Individual
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Provider Name | AMELIE RHOSHUNDA PRUITT
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Gender | Female
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 6465 E MOCKINGBIRD LN STE 344
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City | DALLAS
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State | TX
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Zip | 75214-7018
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Country | US
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Telephone | 469-577-5491
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 PACIFIC AVE APT 1706
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City | DALLAS
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State | TX
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Zip | 75201-4964
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Country | US
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Telephone | 469-577-5491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT137429
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License Number State | TX
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