Individual
ERICA PRUETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 E 63RD ST STE 230, KANSAS CITY, MO 64110-3303
(816) 569-2802
Mailing address
601 E 63RD ST STE 230, KANSAS CITY, MO 64110-3303
(816) 569-2802
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2019028310
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019028310
LICENSE NUMBER
MO
Enumeration date
08/28/2019
Last updated
08/28/2019
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