Provider Demographics
NPI:1558406785
Name:TRUITT, DEBRA NICOLE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:NICOLE
Last Name:TRUITT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:SPANISHBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25922-0149
Mailing Address - Country:US
Mailing Address - Phone:304-920-0100
Mailing Address - Fax:304-324-0548
Practice Address - Street 1:504A CHERRY ST
Practice Address - Street 2:BUILDING D
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3306
Practice Address - Country:US
Practice Address - Phone:304-327-8686
Practice Address - Fax:304-324-0548
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2000-0453225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist