Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PTL0002414 | CO |
NPI | 1245665504 |
---|---|
Provider Name | Ms. Jean M. Pruitt |
First Address | Westminster, CO 80031-6956 |
Second Address | Westminster, CO 80031-6956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2013 |
Last Update Date | 05/09/2013 |