Provider Demographics
NPI:1093975476
Name:TRUITT, ZACHARY DEAN (PT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DEAN
Last Name:TRUITT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37390 PERKINS RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3719
Mailing Address - Country:US
Mailing Address - Phone:225-677-5464
Mailing Address - Fax:
Practice Address - Street 1:37390 PERKINS RD
Practice Address - Street 2:SUITE J
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3719
Practice Address - Country:US
Practice Address - Phone:225-677-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00514R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56409Medicare PIN