Provider Demographics
NPI:1770239790
Name:PRUITT, AYNSLEY (DPT)
Entity Type:Individual
Prefix:
First Name:AYNSLEY
Middle Name:
Last Name:PRUITT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 CLAIRMONT AVE S APT 212
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-3528
Mailing Address - Country:US
Mailing Address - Phone:662-424-3736
Mailing Address - Fax:
Practice Address - Street 1:3780 RIVERCHASE VLG STE 900
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1210
Practice Address - Country:US
Practice Address - Phone:205-349-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH10474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist