Provider Demographics
NPI:1831506740
Name:PRUITT, COURTNEY (ATC/L)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:PRUITT
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 LAUREL GROVE CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1323
Mailing Address - Country:US
Mailing Address - Phone:845-742-9357
Mailing Address - Fax:
Practice Address - Street 1:129 LAUREL GROVE CT
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1323
Practice Address - Country:US
Practice Address - Phone:845-742-9357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT54432255A2300X
TN12952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer