MEDICARE: DR. BRENT PRITT DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1326663196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT PRITT DPT

Provider Business Mailing Address
First Line	:	351 WARWICK DR
Second Line	:
City	:	BENICIA
State	:	CA
Zip	:	94510-2142
Country	:	US
Telephone Number	:	707-208-9537
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 LYNCH CREEK WAY
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-2342
Country	:	US
Telephone Number	:	707-763-2340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	06/08/2020

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