Provider Demographics
NPI:1255171849
Name:PRITULA, KEVIN DAVID
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DAVID
Last Name:PRITULA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 WOODLAND BLF NE
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9605
Mailing Address - Country:US
Mailing Address - Phone:616-822-7099
Mailing Address - Fax:
Practice Address - Street 1:6821 WOODLAND BLF NE
Practice Address - Street 2:
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-9605
Practice Address - Country:US
Practice Address - Phone:616-822-7099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer