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General NPI Number Information
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NPI Number | 1023691458
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Entity Type | Individual
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Provider Name | AMANDA FREEMAN PRUITT PT, DPT, GCS, CEEAA
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Gender | Female
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 335 STREAMLAND DR
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City | DANVILLE
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State | KY
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Zip | 40422-1081
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Country | US
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Telephone | 606-424-7483
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Fax |
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Provider Business Mailing Address
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Address Line | 335 STREAMLAND DR
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City | DANVILLE
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State | KY
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Zip | 40422-1081
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Country | US
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Telephone | 606-424-7483
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 005486
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License Number State | KY
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