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General NPI Number Information
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NPI Number | 1245538024
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Entity Type | Individual
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Provider Name | LESLIE ANN PRUITT DPT
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Gender | Female
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Dates
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Enumeration Date | 03/03/2011
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 909 UNIVERSITY ST 217
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City | SEATTLE
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State | WA
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Zip | 98101-2772
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Country | US
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Telephone | 206-341-1131
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Fax |
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Provider Business Mailing Address
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Address Line | 17624 133RD PL SE
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City | RENTON
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State | WA
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Zip | 98058-6839
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Country | US
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Telephone | 206-356-3548
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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 | PT60209140
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License Number State | WA
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