Provider Demographics
NPI:1992182125
Name:PRUITT, GLOICIE DARLENE (PT)
Entity Type:Individual
Prefix:
First Name:GLOICIE
Middle Name:DARLENE
Last Name:PRUITT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:3625 BRASELTON HWY
Practice Address - Street 2:STE 204
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1014
Practice Address - Country:US
Practice Address - Phone:770-932-9521
Practice Address - Fax:770-932-9523
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist