Provider Demographics
NPI:1982037263
Name:PRUITT, TRISH L (CMT)
Entity Type:Individual
Prefix:
First Name:TRISH
Middle Name:L
Last Name:PRUITT
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1648 E HERNDON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3381
Mailing Address - Country:US
Mailing Address - Phone:559-432-7222
Mailing Address - Fax:559-432-7541
Practice Address - Street 1:1648 E HERNDON AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3381
Practice Address - Country:US
Practice Address - Phone:559-432-7222
Practice Address - Fax:559-432-7541
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA35893225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35893OtherUNITED HEALTHCARE