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General NPI Number Information
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NPI Number | 1558406785
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Entity Type | Individual
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Provider Name | DEBRA NICOLE TRUITT LMT
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 504A CHERRY ST BUILDING D
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City | BLUEFIELD
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State | WV
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Zip | 24701-3306
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Country | US
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Telephone | 304-327-8686
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Fax | 304-324-0548
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Provider Business Mailing Address
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Address Line | PO BOX 149
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City | SPANISHBURG
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State | WV
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Zip | 25922-0149
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Country | US
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Telephone | 304-920-0100
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Fax | 304-324-0548
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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 | 2000-0453
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License Number State | WV
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