Provider Demographics
NPI:1023691458
Name:PRUITT, AMANDA FREEMAN (PT, DPT, GCS, CEEAA)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:FREEMAN
Last Name:PRUITT
Suffix:
Gender:F
Credentials:PT, DPT, GCS, CEEAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 STREAMLAND DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1081
Mailing Address - Country:US
Mailing Address - Phone:606-424-7483
Mailing Address - Fax:
Practice Address - Street 1:335 STREAMLAND DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1081
Practice Address - Country:US
Practice Address - Phone:606-424-7483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist