| NPI | 1396086047 |
|---|---|
| Former Name | LAURA RAE PRUETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT41206) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207798) |
| 225100000X Physical Therapist (Licence: GA PT010414) | |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2020-02-11 |