Active NPI
Kristen Agnew Pruitt, M.S, PT
- Physical Therapist
- Gainesville, GA
National Provider Identifier
1114012911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT004847
- Practice address
- 4615 Enfield Dr
Gainesville, GA 30506-4663 - Phone
- (678) 450-1174
- Fax
- (678) 450-1174
- NPI assigned
- Oct 4, 2006
- Last updated
- Jul 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT004847 | GA | Primary |
Addresses
Primary practice location
4615 Enfield Dr
Gainesville, GA 30506-4663
Mailing address
4615 Enfield Dr
Gainesville, GA 30506-4663
Phone (678) 450-1174
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10054142 | Other | GA | AMERIGROUP PROVIDER # |
| PT004847 | Other | GA | PHYSICAL THERAPY LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT004847 | GA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walker Therapy Services | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1114012911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4615 ENFIELD DR",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305064663",
"telephone_number": "678-450-1174",
"fax_number": "678-450-1174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4615 ENFIELD DR",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305064663",
"telephone_number": "678-450-1174",
"fax_number": "678-450-1174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUITT",
"first_name": "KRISTEN",
"middle_name": "AGNEW",
"name_prefix": "Mrs.",
"credential": "M.S, PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT004847",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP PROVIDER #",
"identifier": "10054142",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICAL THERAPY LICENSE",
"identifier": "PT004847",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, GA
- Professional Therapy Services, LLC
- Professional Therapy Services, LLC (Pro Therapy)
- Prosalud Medical Center
- Prosthetic Care, LLC (Procare Prosthetics and Orthotics)
- Jordan Pruitt, PA
- Lisa Carol Pruitt, LPN
- Pruitthealth Home Health, Inc. (PruittHealth @ Home - Gainesville)
- Pruitthealth Hospice, Inc. (PruittHealth Hospice - Gainesville)
- Psychiatry and Psychological Associates LLC
- Psychotherapy and Assessment Services
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.