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NPI Code Detail

MEDICARE: KASEY JO LANTRIP-PRUETT PTA

MEDICARE: KASEY JO LANTRIP-PRUETT PTA
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
1225200000XPhysical Therapy Assistant2083287TX

General Provider Information

NPI Number : 1679053672
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASEY JO LANTRIP-PRUETT PTA
Provider Business Mailing Address
First Line : 608 CADDELL ST
Second Line :
City : AUBREY
State : TX
Zip : 76227-9231
Country : US
Telephone Number : 940-390-0084
Fax Number :
Provider Business Practice Location Address
First Line : 205 N BONNIE BRAE ST
Second Line :
City : DENTON
State : TX
Zip : 76201-3766
Country : US
Telephone Number : 940-703-7227
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2018
Last Update Date : 08/19/2018

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