Provider Demographics
NPI:1982017141
Name:PRUE, KEVIN (PT,DPT,CSCS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:PRUE
Suffix:
Gender:M
Credentials:PT,DPT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SOUTHHILL DR STE 140
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8629
Mailing Address - Country:US
Mailing Address - Phone:919-678-8828
Mailing Address - Fax:
Practice Address - Street 1:1020 SOUTHHILL DR STE 140
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8629
Practice Address - Country:US
Practice Address - Phone:919-678-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist