Individual
SHANNON PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
851 NW 45TH ST, #209, KANSAS CITY, MO 64116-4628
(816) 452-1633
(816) 452-1635
Mailing address
851 NW 45TH ST, #209, KANSAS CITY, MO 64116-4628
(816) 452-1633
(816) 452-1635
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2005036205
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005036205
PT LICENSE #
MO
Enumeration date
05/27/2016
Last updated
05/27/2016
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