Provider Demographics
NPI:1063878437
Name:DELL-PRUETT, MICHELE (PHD, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:DELL-PRUETT
Suffix:
Gender:F
Credentials:PHD, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 RALPH DELL RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1131
Mailing Address - Country:US
Mailing Address - Phone:615-427-1077
Mailing Address - Fax:
Practice Address - Street 1:822 W LAKE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1241
Practice Address - Country:US
Practice Address - Phone:410-377-5192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00006832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer