Provider Demographics
NPI:1902200967
Name:PRUE, MARGARET
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:PRUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29120 PONDFORK RD
Mailing Address - Street 2:
Mailing Address - City:BIM
Mailing Address - State:WV
Mailing Address - Zip Code:25021-0005
Mailing Address - Country:US
Mailing Address - Phone:304-247-6768
Mailing Address - Fax:
Practice Address - Street 1:29120 SPRING HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BIM
Practice Address - State:WV
Practice Address - Zip Code:25021-0005
Practice Address - Country:US
Practice Address - Phone:304-247-6768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist