Provider Demographics
NPI:1033169735
Name:PRUSS, DENNIS EDWARD (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:EDWARD
Last Name:PRUSS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1925
Mailing Address - Country:US
Mailing Address - Phone:806-783-8605
Mailing Address - Fax:806-783-8604
Practice Address - Street 1:4601 S LOOP 289
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2206
Practice Address - Country:US
Practice Address - Phone:806-792-7200
Practice Address - Fax:806-792-7225
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT04592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer