Provider Demographics
NPI:1619943339
Name:PRUITT, TOMMY SCOTT (RPT)
Entity Type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:SCOTT
Last Name:PRUITT
Suffix:
Gender:M
Credentials:RPT
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 2138
Mailing Address - Street 2:44 HUGHES RD STE 1050
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-5416
Mailing Address - Country:US
Mailing Address - Phone:256-325-5400
Mailing Address - Fax:256-325-5469
Practice Address - Street 1:44 HUGHES RD STE 1050
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2237
Practice Address - Country:US
Practice Address - Phone:256-325-5400
Practice Address - Fax:256-325-5469
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51531324OtherBCBS
AL8959491OtherCIGNA
AL7170141OtherAETNA
S95685Medicare UPIN
AL51531324OtherBCBS