MEDICARE: AYNSLEY PRUITT 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	PTH10474	AL

General Provider Information

NPI Number	:	1770239790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYNSLEY PRUITT DPT

Provider Business Mailing Address
First Line	:	3500 CLAIRMONT AVE S APT 212
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35222-3528
Country	:	US
Telephone Number	:	662-424-3736
Fax Number	:

Provider Business Practice Location Address
First Line	:	3780 RIVERCHASE VLG STE 900
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-1210
Country	:	US
Telephone Number	:	205-349-9494
Fax Number	:

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

Provider Enumeration Date	:	02/28/2022
Last Update Date	:	02/28/2022

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Directions to “ AYNSLEY PRUITT DPT” Practice Location

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