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General NPI Number Information
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NPI Number | 1679053672
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Entity Type | Individual
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Provider Name | KASEY JO LANTRIP-PRUETT PTA
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Gender | Female
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Dates
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Enumeration Date | 08/19/2018
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Last Update Date | 08/19/2018
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Provider Practice Location Address
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Address Line | 205 N BONNIE BRAE ST
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City | DENTON
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State | TX
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Zip | 76201-3766
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Country | US
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Telephone | 940-703-7227
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Fax |
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Provider Business Mailing Address
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Address Line | 608 CADDELL ST
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City | AUBREY
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State | TX
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Zip | 76227-9231
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Country | US
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Telephone | 940-390-0084
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2083287
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License Number State | TX
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