Individual
TONYA MICHELLE PRUITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3100 CLUB DR, LAWRENCEVILLE, GA 30044-2591
(770) 923-3100
Mailing address
219 EVANS DR, DANIELSVILLE, GA 30633-4944
(706) 988-1970
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002287
GA
Other
Enumeration date
12/10/2012
Last updated
12/10/2012
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