Provider Demographics
NPI:1669769964
Name:PRUITT, SAMANTHA (DPT)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:PRUITT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:CHEATHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:10014 N RODNEY PARHAM RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-5598
Mailing Address - Country:US
Mailing Address - Phone:501-224-5454
Mailing Address - Fax:
Practice Address - Street 1:10014 N RODNEY PARHAM RD
Practice Address - Street 2:STE. 100
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-5598
Practice Address - Country:US
Practice Address - Phone:501-224-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist