Provider Demographics
NPI:1043539828
Name:PRATT, JOY ELLEN (LMT, RYT)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:ELLEN
Last Name:PRATT
Suffix:
Gender:F
Credentials:LMT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E GRANADA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-6634
Mailing Address - Country:US
Mailing Address - Phone:386-631-1299
Mailing Address - Fax:
Practice Address - Street 1:4 ARBORVUE TRL
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5168
Practice Address - Country:US
Practice Address - Phone:386-631-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56495171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor