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General NPI Number Information
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NPI Number | 1619542875
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Entity Type | Individual
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Provider Name | VICTORIA PRUITT PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 05/20/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 1525 RIDGEWOOD DR
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City | MIDLAND
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State | MI
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Zip | 48642-6425
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Country | US
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Telephone | 989-835-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 15 DARTMOOR PL
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City | MIDLAND
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State | MI
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Zip | 48640-3382
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Country | US
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Telephone | 517-990-5603
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 5501020028
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License Number State | MI
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